Bernard, Larry C
Two studies investigate relationships between individual differences in motivation and borderline personality disorder, psychopathy, and maladjustment. Participants completed the Brief Assessment of Individual Motives 1--Revised, a measure of 15 putative evolved motives (i.e., "traits of action"). In Study 1, N = 147 adult participants also completed the Borderline Personality Questionnaire and Self-Report Psychopathy III Questionnaire (SRP III). In Study 2, N = 135 college age participants also completed the SRP III and the Counseling Center Assessment of Psychological Symptoms-62. Regression analyses suggested that individual differences in motivational traits account for moderate amounts of variance in measures of antisocial personality disorder, psychopathy, and maladjustment. They also suggested that lower motivation to engage in cooperative behaviors (e.g., sharing resources and forming coalitions) is related to impaired interpersonal relationships and maladjustment.
Blonigen, Daniel M; Sullivan, Elizabeth A; Hicks, Brian M; Patrick, Christopher J
Despite the high prevalence of trauma exposure in female prisoners, few studies have examined the link between psychopathy and posttraumatic stress disorder (PTSD)-or the potential mediating role of borderline personality disorder traits. Using a sample of incarcerated women, we identified differential associations across facets of psychopathy, as assessed via the Psychopathy Checklist-Revised (PCL-R; Hare, 2003), with potentially traumatic events (PTE) and symptoms of PTSD. Specifically, the Interpersonal and Affective facets were unrelated to both PTE and PTSD, while the Lifestyle and Antisocial facets were each associated with PTE and the Antisocial facet was uniquely associated with PTSD symptoms. Borderline personality disorder traits fully accounted for the association between the Antisocial facet and both PTE and PTSD, while the Lifestyle facet contributed incrementally to the prediction of PTE. The findings clarify linkages among psychopathy, trauma, PTSD, and borderline personality disorder traits, and extend our understanding of the clinical presentation of psychopathy in women.
Personality disorder - borderline ... Cause of borderline personality disorder (BPD) is unknown. Genetic, family, and social factors are thought to play roles. Risk factors for BPD include: Abandonment ...
Søderberg, Ene Alicia; KALININA, NATALLIA; Winther Kestner, Kamma; Ettrup Andresen, Lærke
This study investigates the relation between the term psychopathy formulated by Robert D. Hare, and the official diagnosis of antisocial personality disorder (ASPD). In relation to this, the project discusses the development of moral judgment and empathy, and under which conditions one might develop psychopathy and ASPD - how it is sociologically and biologically wired. Furthermore, we will take into consideration the ethical issues of labeling. We will discuss difficulties and possibilities ...
Miller, Joshua D; Lynam, Donald R
Nine original articles comprise this special issue of the Journal of Personality addressing personality-based perspectives of psychopathy. In this introduction to the special issue, we review five advances and areas of agreement that are highlighted across the articles, including the utility of trait perspectives to psychopathy, the emergence of a prototypical trait profile of psychopathy, the importance of recognizing earlier developmental manifestations of psychopathy, the ongoing study and revelation of the basic neural underpinnings of psychopathy, and the important theoretical and empirical association between psychopathy and antisocial behavior. At the same time, several important debates remain, which are also highlighted in the special issue's articles. These debates center around the necessity and sufficiency of certain psychopathy traits, the role of traits alternatively labeled stable Extraversion, fearless dominance, or boldness, and the validity and utility of separating psychopathy from Machiavellianism as is done in research on the Dark Triad.
Ogloff, James R P
Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those
Strickland, Casey M; Drislane, Laura E; Lucy, Megan; Krueger, Robert F; Patrick, Christopher J
Despite its importance historically and contemporarily, psychopathy is not recognized in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR). Its closest counterpart, antisocial personality disorder, includes strong representation of behavioral deviance symptoms but weak representation of affective-interpersonal features considered central to psychopathy. The current study evaluated the extent to which psychopathy and its distinctive facets, indexed by the Triarchic Psychopathy Measure, can be assessed effectively using traits from the dimensional model of personality pathology developed for DSM-5, operationalized by the Personality Inventory for DSM-5 (PID-5). Results indicate that (a) facets of psychopathy entailing impulsive externalization and callous aggression are well-represented by traits from the PID-5 considered relevant to antisocial personality disorder, and (b) the boldness facet of psychopathy can be effectively captured using additional PID-5 traits. These findings provide evidence that the dimensional model of personality pathology embodied in the PID-5 provides effective trait-based coverage of psychopathy and its facets.
Although Borderline Personality Disorder (BPD) overlaps considerably with Major Depression, recent studies of biology, genetics and childhood trauma have demonstrated that there are substantial differences between the two disorders. It is suggested that their apparent relationship is rather nonspecific. In this paper, the author emphasizes that the core symptom of BPD is impulsiveness, which causes depressive symptoms and/or is induced by depressive episodes, forming a vicious cycle. Furthermore, in BPD patients, depressive symptoms are modified by impulsiveness, masochism, vanity, despair, and difficulties in interpersonal relationships. The author concludes that BPD is not a homogeneous but heterogeneous syndrome, classified into subtypes: depressive type, impulsive type, and identity diffusion type. Treatment needs to be considered according to these types.
Full Text Available ... Psychotherapy (TFP) This form of therapy is rooted in the patient’s confused and contradictory sense of identity ... person to another person, such as the therapist. In that moment, the therapist talks with the patient ...
Acklin, M W
The borderline conditions have been the focus of considerable debate and controversy for over 30 years. This article, second in a series of three articles focusing on Kernberg's (1975, 1984) psychostructural diagnosis of personality organization, examines Rorschach contributions to the description and diagnosis of borderline personality organization. Rorschach approaches integrating nomothetic and idiographic data are applied to borderline personality functioning and appraised in light of the Rorschach's contribution to the clarification of the controversial and poorly delineated borderline diagnosis.
Gil, Tsvi E
The present article critically discusses diagnosing borderline personality, demonstrating ideas raised with a treated case. In contrast to routine diagnoses made by psychiatrists according to common diagnosing systems (such as the American DSM or the WHO's ICD), we wonder whether this diagnosis reflects a medico-social construct, which is associated to the female status in masculine (or even patriarch) society, and probably associated even to the context of a woman diagnosed by a psychiatric system. In the context of critically viewing aetiological hypotheses to borderline personality (presented in our former article as a personality constellated around complex and prolonged trauma) in this article we suggest viewing borderline behaviours and symptoms as manifestations of coping and survival of a woman-victim in abusing surroundings.
Bech, Morten; Elklit, Ask; Simonsen, Erik
Borderline personality disorder is a severe psychiatric illness. A key feature of the disorder is a disorganized sense of self often referred to as identity diffusion. Autobiographical memory is memory for personal life events. One of the main functions of these memories is to enable us...... to understand who we are by connecting past, present and future experiences. It seems that autobiographical memory is in some way disrupted in individuals with borderline personality disorder. A systematic review is conducted looking at studies that focus on the potential connections. We find that although......, autobiographical memory and borderline personality disorder....
Ogłodek, Ewa; Araszkiewicz, Aleksander
For many years, the borderline personality disorders have mainly been researched in terms of psychoanalytical theories, such as theories on relations with the object. Nowadays, there are three kinds of concepts that are distinguishable. The first ones are those which are group models, serving attempts to made characteristic sets of qualities, represented by individuals suffering from the borderline personality disorders, more precise. The remaining concepts are models of conflict and deficit, which explain complicated mechanisms of interactions of social, psychological and biological factors, and therefore, contribute to better understanding of the genesis of the symptoms of this disorder. Upon the basis of the attempts made so far in the field of describing the borderline personality disorders, one may indicate certain criteria, representative for the entire group of individuals with this diagnosis, regardless of the assumptions applicable to the genesis of the disorder and its symptoms, even though the population of the infirm suffering from the borderline personality disorders is not internally homogenous. The interest of psychologists, attempting to describe the borderline personality disorders, is focused upon certain sets of qualities, presented as the examples of descriptive models. Among the researchers, working on the issues of the borderline personality disorders in this manner, there are: Gunderson, Kernberg, Kohut, Winnicot, Guntrip, Fairbaim, Adler and Buie.
Zeier, Joshua D; Baskin-Sommers, Arielle R; Hiatt Racer, Kristina D; Newman, Joseph P
Antisociality has been linked to a variety of executive functioning deficits, including poor cognitive control. Surprisingly, cognitive control deficits are rarely found in psychopathic individuals, despite their notoriously severe and persistent antisocial behavior. In fact, primary (low-anxious) psychopathic individuals display superior performance on cognitive control-type tasks under certain circumstances. To clarify these seemingly contradictory findings, we administered a response competition (i.e., flanker) task to incarcerated offenders, who were assessed for Antisocial Personality Disorder (APD) symptoms and psychopathy. As hypothesized, APD related to poorer accuracy, especially on incongruent trials. Contrary to expectation, however, the same pattern of results was found in psychopathy. Additional analyses indicated that these effects of APD and psychopathy were associated with overlapping variance. The findings suggest that psychopathy and APD symptoms are both associated with deficits in cognitive control, and that this deficit relates to general antisociality as opposed to a specific antisocial syndrome.
Atmaca, Murad; Korkmaz, Sevda; Ustundag, Bilal; Ozkan, Yusuf
Although there is an important interaction between serotonergic system, prolactin and suicidal behavior, and impulsivity, no investigation examined the prolactin values in borderline personality disorder in which suicidal behavior and impulsivity are core symptom dimensions. In this context, in the present investigation, we planned to measure serum prolactin levels in the patients with borderline personality disorder. The study comprised 15 patients with borderline personality disorder and 15 healthy controls. Prolactin values were measured in both patients and control subjects. The patients had abnormally higher mean value of prolactin compared to those of healthy controls (48.66 ± 36.48 mg/dl for patients vs. 15.20 ± 7.81 mg/dl for healthy controls). There was no correlation between prolactin values and any demographic variables for both the patients and control subjects. In conclusion, our present results suggest that prolactin values increased in the patients with borderline personality disorder and are required to be replicated by more comprehensive and detailed further studies to decipher the exact roles of prolactin increase.
Gacono, C B; Meloy, J R; Berg, J L
Rorschach data were used to psychometrically "map" the internal psychological operations of three Cluster B personality disorders, listed in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987), all of which may be organized at a borderline level. Psychopathic antisocial subjects (P-APDs) and narcissistic subjects (NPDs) were highly narcissistic. NPD subjects, however, produced more indices of anxiety and attachment capacity and fewer scores related to borderline object relations and damaged identity. P-APDs and borderline subjects (BPDs) produced similar mean numbers of borderline object relations; however, the BPDs were more anxious, produced more unsublimated aggressive and libidinal drive material, and evidenced greater potential for attachment. BPDs were also less narcissistic than both P-APDs and NPDs. Nonpsychopathic antisocial subjects (NP-APDs) were less borderline than P-APDs and BPDs, less narcissistic in terms of a stable grandiose self-structure than NPD and P-APDs, produced less evidence of attachment capacity than NPDs and BPDs but more than P-APDs, and were similar to BPDs in their proneness to anxiety. The outpatient NPDs and BPDs produced more idealization responses than the incarcerated antisocial personality disorder (APD) groups. We conclude that the behavioral descriptions offered for these three Cluster B personality disorders, when used in conjunction with information such as level of personality organization (Kernberg, 1984), level of psychopathy (Hare, 1980, 1985), and outpatient versus inpatient research settings, may have greater intrapsychic specificity than previously thought.
Salekin, Randall T.; Leistico, Anne-Marie R.; Trobst, Krista K.; Schrum, Crystal L.; Lochman, John E.
The construct validity of psychopathy was examined in a sample of 114 male and female young offenders ([M.sub.age] = 15.16) at a southeastern detention center. The interpersonal circumplex served as a framework of general personality from which to examine the construct of adolescent psychopathy. A supplementary analysis of the psychopathy measures…
de Groot, E.R.; Verheul, R.; Trijsburg, R.W.
Although there is an abundance of literature on the psychotherapeutic treatment of borderline pathology, little is known about differences and similarities between treatments of borderline personality disorder (BPD). Potential differences and similarities are especially important in the absence of e
Kellogg, Scott H; Young, Jeffrey E
This article presents the Schema Therapy (Young, Klosko, & Weishaar, 2003) approach to the treatment of borderline personality disorder. Schema therapy draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions and conceptualizes patients who have borderline personality disorder as being under the sway of five modes or aspects of the self. The goal of the therapy is to reorganize this inner structure. To this end, there are four core mechanisms of change that are used in this therapy: (1) limited reparenting, (2) experiential imagery and dialogue work, (3) cognitive restructuring and education, and (4) behavioral pattern breaking. These interventions are used during the three phases of treatment: (1) bonding and emotional regulation, (2) schema mode change, and (3) development of autonomy.
Helgeland, Margareth I; Torgersen, Svenn
Developmental antecedents of borderline personality disorders (BPDs) were examined in 25 DSM-IV-diagnosed subjects with BPD and 107 non-borderline control subjects on the basis of medical records and 28 years follow-up. Abuse, neglect, environmental instability, paternal psychopathology, and lower score on protective factors differentiated significantly between the groups. Environmental instability and lower score on protective factors such as artistic talents, superior school performance, above average intellectual skills, and talents in other areas were found to be independent predictors of BPD diagnosis. The results of this study suggest that both abuse and neglect, unpredictable and unstable early environment, as well as deficit in protective factors may substantially contribute to the development of BPD in persons constitutionally predisposed for the disorder. The results of the study also suggest that future research should address the impact of social and cultural context, as well as the absence of protective factors, on the development of the BPD.
Stone, M H
In the early 1890s Freud expressed the belief that many cases of hysteria had a basis in childhood incest. Later he expressed a different view, emphasizing childhood fantasies of sexual intimacies with a parent that never actually took place. Freud never totally repudiated his original seduction theory, however, maintaining to the end of his life that at least some cases of actual incest occurred and that these instances underlay certain types of psychopathology. In our era we have become aware that incest is frequently a forerunner of subsequent borderline disorders, especially in women hospitalized with borderline personality disorder (B.P.D.). All the clinical manifestations of B.P.D. can be related to the prior incest experiences.
Cale, Ellison M; Lilienfeld, Scott O
Little is known about the etiology of histrionic personality disorder (HPD) or its relation to other personality disorders. In this study, we examined whether HPD is etiologically related to psychopathy and more specifically whether HPD and antisocial personality disorder (ASPD) are sex-typed alternative manifestations of psychopathy. In addition, based on Newman's (1987) response modulation hypothesis of psychopathy, we examined the associations between psychopathic, HPD, and ASPD features and performance on laboratory measures of passive avoidance errors and interference effects. Seventy-five live theater actors completed self-report questionnaires and two laboratory measures of response modulation, and peers completed questionnaires concerning the participants' personality disorder features. The results provided weak and inconsistent support for the hypotheses that HPD is a female-typed variant of psychopathy and that ASPD is a male-typed variant of psychopathy. Contrary to previous findings, scores on response modulation tasks were not significantly related to psychopathy, or to either HPD or ASPD. The limitations of this study and possibilities for future research in this area are outlined.
Hege Nordem Sjåstad
Full Text Available BACKGROUND: The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders. METHODS: In a national cross-sectional study of patients receiving mental health treatment in Norway (N = 36 773, we determined whether psychiatric outpatients with borderline personality disorder (N = 1 043 had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N = 2 636. Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice. RESULTS: More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders. CONCLUSIONS: The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than
Clifton, Allan; Pilkonis, Paul A; McCarty, Christopher
The interpersonal dysfunction that characterizes borderline personality disorder (BPD) has generally been studied using broad global measures, leading to a lack of precision. We report on a novel methodology using social network analysis (SNA) to quantify interactions with others in the patient's social world. We assessed the social networks of 22 clinical patients, diagnosed with either BPD (N = 11) or no personality disorder (No PD; N = 11). The social networks of patients with BPD contained a greater number of former romantic partners, and a greater number of relationships that had been terminated. Mixed model analyses found that the No PD group reported higher levels of positive relationships (e.g., trust, social support) with more central members of their social networks, whereas the BPD group did not discriminate among members of their networks. Results suggest deficits in social cognition for positive relations, but not for negative relations such as interpersonal conflict.
Feske, Ulrike; Tarter, Ralph E; Kirisci, Levent; Pilkonis, Paul A
The association between borderline personality disorder (BPD) and substance use disorder (SUD) was examined in a predominantly psychiatric (77.6%) sample of 232 women. BPD proved to be a significant predictor of a lifetime diagnosis of SUD across four different categories: any SUD (including alcohol); alcohol use; drug use; and heroin, cocaine, or poly-substance use. BPD continued to be a predictor of SUD even when the effects of other cluster B and all cluster C PDs were controlled statistically. Antisocial personality disorder generally yielded larger odds ratios than BPD and emerged as a partial mediator of the relation between BPD and SUD. Histrionic PD was the only other PD that showed meaningful relations with SUD.
Peter, Mathell; Schuurmans, Hanneke; Vingerhoets, Ad J J M; Smeets, Guus; Verkoeijen, Peter; Arntz, Arnoud
The present study investigated emotional intelligence (EI) in borderline personality disorder (BPD). It was hypothesized that patients with BPD (n = 61) compared with patients with other personality disorders (PDs; n = 69) and nonpatients (n = 248) would show higher scores on the ability to perceive emotions and impairments in the ability to regulate emotions. EI was assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test (Mayer, Salovey, and Caruso [New York: MHS, 2002]). As compared with the PD group and the nonpatient group, the patients with BPD displayed the anticipated deficits in their ability to understand, whereas no differences emerged with respect to their ability to perceive, use, and regulate emotions. In addition, a negative relationship was found between the severity of BPD and total EI score. However, this relationship disappeared when intelligence quotient was partialled out. These results suggest that BPD is associated with emotion understanding deficits, whereas temporary severity of BPD is associated with emotion regulation deficits.
Sleep problems are very common among psychiatric patients. Borderline personality disorder, as a common and severe mental disorder, is associated with different types of sleep disturbances, such as disturbances of sleep continuity, altered REM sleep regulation and nightmares. These disturbances are the result of interaction of the personality traits, concomitant and comorbid diseases and environmental factors. Despite the high prevalence of sleep related disorders in BPD patients, this aspect of BPD is still neglected in clinical and research settings. To date there has been little agreement on sleep characteristics of BPD among different studies, and presence of some uncontrolled confounding factors, make interpretation of the results difficult. However, it seems that appropriate diagnosis and treatment of sleep disorders in BPD patients might lead to better outcome. This article aimed to review the current literature of sleep studies in BPD. Some recommendations and suggestions were made for future researches in this field.
Full Text Available BACKGROUND: One of the core symptoms of borderline personality disorder (BPD is the instability in interpersonal relationships. This might be related to existent differences in mindreading between BPD patients and healthy individuals. METHODS: We examined the behavioural and neurophysiological (fMRI responses of BPD patients and healthy controls (HC during performance of the 'Reading the Mind in the Eyes' test (RMET. RESULTS: Mental state discrimination was significantly better and faster for affective eye gazes in BPD patients than in HC. At the neurophysiological level, this was manifested in a stronger activation of the amygdala and greater activity of the medial frontal gyrus, the left temporal pole and the middle temporal gyrus during affective eye gazes. In contrast, HC subjects showed a greater activation in the insula and the superior temporal gyri. CONCLUSION: These findings indicate that BPD patients are highly vigilant to social stimuli, maybe because they resonate intuitively with mental states of others.
Distel, Marijn A; Smit, Johannes H; Spinhoven, Philip; Penninx, Brenda W J H
Anxiety and depression frequently co-occur with borderline personality disorder. Relatively little research examined the presence of borderline personality features and its main domains (affective instability, identity problems, negative relationships and self-harm) in individuals with remitted and current anxiety and depression. Participants with current (n=597) or remitted (n=1115) anxiety and/or depression and healthy controls (n=431) were selected from the Netherlands Study of Depression and Anxiety. Assessments included the Personality Assessment Inventory - Borderline Features Scale and several clinical characteristics of anxiety and depression. Borderline personality features were more common in depression than in anxiety. Current comorbid anxiety and depression was associated with most borderline personality features. Anxiety and depression status explained 29.7% of the variance in borderline personality features and 3.8% (self-harm) to 31% (identity problems) of the variance in the four domains. A large part of the variance was shared between anxiety and depression but both disorders also explained a significant amount of unique variance. The severity of anxiety and depression and the level of daily dysfunctioning was positively associated with borderline personality features. Individuals with a longer duration of anxiety and depression showed more affective instability and identity problems. These findings suggest that patients with anxiety and depression may benefit from an assessment of personality pathology as it may have implications for psychological and pharmacological treatment.
Lilienfeld, Scott O; Watts, Ashley L; Francis Smith, Sarah; Berg, Joanna M; Latzman, Robert D
The psychopathy field has long been beset by confusion and contention regarding the boundaries and features of this chimerical condition. We propose that this disagreement stems largely from the historical separation between psychopathy and basic personality psychology. Using findings from a meta-analysis of the correlations between the Psychopathy Checklist-Revised (PCL-R) and normal-range personality traits as a launching point, we (a) deconstruct widely used measures of psychopathy into their constituent subdimensions and (b) examine the associations of these subdimensions with higher-order and lower-order personality dimensions drawn from the Big Five and Big Three frameworks. Our review of the adult psychopathy literature reveals broad agreement that psychopathy measures are imbued with low Agreeableness and low Conscientiousness. Nevertheless, substantial disagreement revolves around the place of largely adaptive features, especially high agentic Extraversion, low Neuroticism, and high Openness, within the psychopathy construct. We propose that ongoing debates regarding the nature and boundaries of psychopathy reflect a focus on two differing operationalizations of this condition, each of which reflects a different "species" of individual.
Mohammad Reza Mohammadi
Full Text Available This study aimed to assess the prevalence of borderline personality symptoms in 16-18 year old adolescents.In this cross sectional - descriptive study, 422 high school students (211 boys, 211 girls aged 16-18 were selected by cluster random sampling and simple random sampling in 2011-2012. The participants were assessed using the revised diagnostic interview for borderline questionnaire (DIB-R and demographic questionnaire. Data were analyzed using Pearson correlation coefficient and Spearman correlation coefficient.Of the participants, 0/9% (0/22 % of the 16 year olds, 0.45 % of the 17 year olds and 0/22% of the 18 year olds were diagnosed with borderline personality symptoms. Also, the prevalence of borderline personality symptoms in boys was 0/45 % of the total sample and it was 0/45 % of the total sample in girls. With respect to the relationship between demographic variables (age, sex, location, parents' occupation, parents' kinship, parents' education and birth order and borderline personality symptoms, only parents' kinship showed a weak correlation with borderline personality symptoms.In the view of the prevalence of 0.9% of the borderline personality symptoms in adolescents, attention should be paid to the diagnosis and treatment of this disorder. Furthermore, works need to be done to improve the mental health and quality of life of adolescents.
Levitt, A J; Joffe, R T; Ennis, J; MacDonald, C; Kutcher, S P
Sixty patients with personality disorders were evaluated by several different diagnostic instruments to determine the prevalence of cyclothymia in borderline personality disorder (BPD) and in other personality disorders (OPD). Cyclothymia occurred more frequently in BPD than in OPD, regardless of which diagnostic system was used. In contrast, the prevalence of major, minor, and intermittent depression, hypomania, and bipolar disorder was not significantly different in BPD as compared with OPD. Cyclothymic borderlines and noncyclothymic borderlines could not be distinguished on behavioral or functional measures. These results have implications for the diagnostic validity of both BPD and cyclothymia.
Werner, Kimberly B; Few, Lauren R; Bucholz, Kathleen K
Psychopathy is theorized as a disorder of personality and affective deficits while antisocial personality disorder (ASPD) diagnosis is primarily behaviorally based. While ASPD and psychopathy are similar and are highly comorbid with each other, they are not synonymous. ASPD has been well studied in community samples with estimates of its lifetime prevalence ranging from 1-4% of the general population.(4,5) In contrast, psychopathy is almost exclusively investigated within criminal populations so that its prevalence in the general population has been inferred by psychopathic traits rather than disorder (1%). Differences in etiology and comorbidity with each other and other psychiatric disorders of these two disorders are also evident. The current article will briefly review the epidemiology, etiology, and comorbidity of ASPD and psychopathy, focusing predominately on research completed in community and clinical populations. This paper aims to highlight ASPD and psychopathy as related, but distinct disorders.
Braamhorst, Wouter; Lobbestael, Jill; Emons, Wilco H M; Arntz, Arnoud; Witteman, Cilia L M; Bekker, Marrie H J
This study investigated sex bias in the classification of borderline and narcissistic personality disorders. A sample of psychologists in training for a post-master degree (N = 180) read brief case histories (male or female version) and made DSM classification. To differentiate sex bias due to sex stereotyping or to base rate variation, we used different case histories, respectively: (1) non-ambiguous case histories with enough criteria of either borderline or narcissistic personality disorder to meet the threshold for classification, and (2) an ambiguous case with subthreshold features of both borderline and narcissistic personality disorder. Results showed significant differences due to sex of the patient in the ambiguous condition. Thus, when the diagnosis is not straightforward, as in the case of mixed subthreshold features, sex bias is present and is influenced by base-rate variation. These findings emphasize the need for caution in classifying personality disorders, especially borderline or narcissistic traits.
Simonsen, Erik; Andersen, Rune; Timmerby, Nina
INTRODUCTION: Dysfunction in affect regulation is a prominent feature that grossly impairs behavioural and interpersonal domains of experience and underlies a great deal of the psychopathology in borderline personality disorder (BPD). However, no study has yet been published that evaluates...
Chaine, F; Guelfi, J D; Monier, C; Brun, A; Seunevel, F
A sample of 36 patients considered by French clinicians as suffering from a borderline personality disorder was evaluated using the International Personality Disorder Examination, the Diagnostic Interview for Borderline-Revised, and the Minnesota Multiphasic Personality Inventory. First, global descriptive analysis of the sample elicited the socio-demographic and standard clinical characteristics of the borderline individuals. After diagnostic evaluation, the sample appeared to be quite homogeneous with 25 of the 36 patients evaluated (69.5%) being defined as borderline by two of the three diagnostic systems: ICD 10, DSM III-R and Gunderson (15/36 = 41.5% of patients were defined as borderline by all three systems). It is the types of BL personality co-diagnoses which differentiated the BL subjects in the sample from those classically described in the international literature, since the most frequent personalities were the Dependent and Avoiding ones, not the Antisocial, Histrionic, Narcissistic or Schizotypic personalities of the DSM III-R. ICD 10 elicited the same significant prevalence of Anxious and Dependent personalities. Lastly, the patients diagnosed as borderline both by clinicians and by all diagnostic systems (forming the sample "core") were compared with the rest of the sample with regard to socio-demographic, clinical and diagnostic characteristics. A few hypotheses are proposed on the type of variables that may permit to discriminate between these two types of patients.
Full Text Available Abstract Background The aims of this study were to assess the prevalence of a comorbid Attention Deficit Hyperactivity Disorder (ADHD diagnosis in Borderline Personality Disorder (BPD, and its impact on the clinical presentation of BPD in adolescents, and to determine which type of impulsivity specifically characterizes adolescents with BPD-ADHD. Methods ADHD diagnoses were sought in a sample of 85 DSM-IV BPD adolescents drawn from the EURNET BPD. Axis-I and -II disorders were determined with the K-SADS-PL and the SIDP-IV, respectively. Impulsivity was assessed with the BIS-11. Results 11% (N = 9 of BPD participants had a current ADHD diagnosis. BPD-ADHD adolescents showed higher prevalence of Disruptive disorders (Chi2 = 9.09, p = 0.01 and a non-significant trend for a higher prevalence of other cluster B personality disorders (Chi2 = 2.70, p = 0.08. Regression analyses revealed a significant association between Attentional/Cognitive impulsivity scores and ADHD (Wald Z = 6.69; p = 0.01; Exp(B = 2.02, CI 95% 1.19-3.45. Conclusions Comorbid ADHD influences the clinical presentation of adolescents with BPD and is associated with higher rates of disruptive disorders, with a trend towards a greater likelihood of cluster B personality disorders and with higher levels of impulsivity, especially of the attentional/cognitive type. A subgroup of BPD patients may exhibit developmentally driven impairments of the inhibitory system persisting since childhood. Specific interventions should be recommended for this subsample of BPD adolescents.
Raines, J M; Raines, L C; Singer, M
It has been proposed that Bram Stoker's novel Dracula can best be understood as a dramatic, hyperbolic, and fantastic expression of themes consistent with contemporary psychoanalytic conceptions of borderline personality disorder organization. Such an understanding may, in turn, shed further light on the nature of the intrapsychic world and experiences of borderline patients. Excerpts from the novel can be used to support the conceptualization of recent contributions to object relations theory and the understanding of borderline personality organization. It is uncanny how consistent Dracula's characteristics are to the generally seen complaints of patients suffering from this disorder.
BACKGROUND AND OBJECTIVE: Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients.METHODS: In a consecutive insured sample of male and female chronic pain patients (n=117), who were being initially evaluated by an outpatient pain...
Full Text Available Many typical symptoms of borderline personality disorder (BPD occur within interpersonal contexts, suggesting that BPD is characterized by aberrant social cognition. While research consistently shows that BPD patients have biases in mental state attribution (e.g., evaluate others as malevolent, the research focusing on accuracy in inferring mental states (i.e., cognitive empathy is less consistent. For complex and ecologically valid tasks in particular, emerging evidence suggests that individuals with BPD have impairments in the attribution of emotions, thoughts, and intentions of others (e.g., Preißler et al., 2010. A history of childhood trauma and co-morbid PTSD seem to be strong additional predictors for cognitive empathy deficits. Together with reduced emotional empathy and aberrant sending of social signals (e.g., expression of mixed and hard-to-read emotions, the deficits in attribution might contribute to behavioral problems in BPD. Given the importance of social cognition on the part of both the sender and the recipient in maintaining interpersonal relationships and therapeutic alliance, these impairments deserve more attention.
The term 'Borderline Personality Disorder' (BPD) refers to a psychiatric syndrome that is characterized by emotion dysregulation, impulsivity, risk-taking behavior, irritability, feelings of emptiness, self-injury and fear of abandonment, as well as unstable interpersonal relationships. BPD is not only common in psychiatric populations but also more prevalent in the general community than previously thought, and thus represents an important public health issue. In contrast to most psychiatric disorders, some symptoms associated with BPD may improve over time, even without therapy, though impaired social functioning and interpersonal disturbances in close relationships often persist. Another counterintuitive and insufficiently resolved question is why depressive symptoms and risk-taking behaviors can occur simultaneously in the same individual. Moreover, there is an ongoing debate about the nosological position of BPD, which impacts on research regarding sex differences in clinical presentation and patterns of comorbidity.In this review, it is argued that many features of BPD may be conceptualized within an evolutionary framework, namely behavioral ecology. According to Life History Theory, BPD reflects a pathological extreme or distortion of a behavioral 'strategy' which unconsciously aims at immediate exploitation of resources, both interpersonal and material, based on predictions shaped by early developmental experiences. Such a view is consistent with standard medical conceptualizations of BPD, but goes beyond classic 'deficit'-oriented models, which may have profound implications for therapeutic approaches.
Full Text Available BACKGROUND: Borderline personality disorder (BPD is a common and serious mental illness, associated with a high risk of suicide and self harm. Those with a diagnosis of BPD often display difficulties with social interaction and struggle to form and maintain interpersonal relationships. Here we investigated the ability of participants with BPD to make social inferences from faces. METHOD: 20 participants with BPD and 21 healthy controls were shown a series of faces and asked to judge these according to one of six characteristics (age, distinctiveness, attractiveness, intelligence, approachability, trustworthiness. The number and direction of errors made (compared to population norms were recorded for analysis. RESULTS: Participants with a diagnosis of BPD displayed significant impairments in making judgements from faces. In particular, the BPD Group judged faces as less approachable and less trustworthy than controls. Furthermore, within the BPD Group there was a correlation between scores on the Childhood Trauma Questionnaire (CTQ and bias towards judging faces as unapproachable. CONCLUSION: Individuals with a diagnosis of BPD have difficulty making appropriate social judgements about others from their faces. Judging more faces as unapproachable and untrustworthy indicates that this group may have a heightened sensitivity to perceiving potential threat, and this should be considered in clinical management and treatment.
Borderline personality disorders are complex clinical states with highly polymorphic symptoms and signs, leading to delays in their diagnosis and treatment. All international classifications emphasize certain clinical criteria such as unstable identity and interpersonal relationships, feelings of emptiness or boredom, and pathological impulsiveness. The prevalence is about 2%, with a female-male sex ratio of 2 or 3 to 1. Both adolescents and adults may be affected There is a high risk of suicide, addictive behaviors, eating disorders, and criminality. These individuals frequently have a history of trauma in early childhood, such as separation, loss, physical or sexual abuse, or affective privation. Subjective signs and symptoms are particularly important in the diagnostic and therapeutic evaluation, and this requires an empathic and subtle approach. Standardized and semi-structured interviews may help to identify comorbidities such as thymic disorders, anxiety, addiction, eating disorders, and, in some cases, psychotic symptoms. The psychiatric bio-psycho-social model takes into account multiple pathogenic factors, such as trauma during early development, temperamental instability and other emotional disorders, as well as psychosocial, neurobiological (5HT etc.) and genetic vulnerabilities. Treatment requires optimal integration of psychotherapeutic and pharmacotherapeutic approaches. Emergency intervention must be available in case of delirious or suicidal behavior The clinical course is often lengthy and complex, but outcome may be favorable, provided the principal risk--suicide--is correctly managed,
Rogstad, Jill E; Rogers, Richard
Traditional conceptualizations of psychopathy highlight the importance of affective features as they relate to social deviance; however, little empirical research has actually investigated specific roles of emotion and emotion processing with respect to antisocial conduct. Antisocial personality disorder (APD), prevalent in forensic populations, is commonly associated with psychopathy despite the notable omission of such core affective features in its diagnosis. In this paper, we review the empirical literature on the contribution of emotion to psychopathy and APD, highlighting in particular research on emotion processing and various facets of emotional expression, including empathy and alexithymia. Research findings are discussed on gender differences in emotional functioning and their likely effects on the assessment of psychopathy and APD. Given the known gender differences in the expressions of emotion, the article concludes with recommendations to bridge research for different offender groups, including psychopathy and APD.
Full Text Available Many studies have assessed emotion recognition in patients with Borderline Personality Disorder and considerable evidence has been accumulated on patients' ability to categorize emotions. In contrast, their ability to detect emotions has been investigated sparsely. The only two studies that assessed emotion detection abilities found contradictory evidence on patients' ability to detect angry faces.To clarify whether patients with Borderline Personality Disorder show enhanced detection of angry faces, we conducted three experiments: a laboratory study (n = 53 with a clinical sample and two highly powered web studies that measured Borderline features (n1 = 342, n2 = 220. Participants in all studies completed a visual search paradigm, and the reaction times for the detection of angry vs. happy faces were measured.Consistently, data spoke against enhanced detection of angry faces in the Borderline groups, indicated by non-significant group (Borderline vs. healthy control × target (angry vs. happy interactions, despite highly satisfactory statistical power to detect even small effects.In contrast to emotion categorization, emotion detection appears to be intact in patients with Borderline Personality Disorder and individuals high in Borderline features. The importance of distinguishing between these two processes in future studies is discussed.
Perry, J Christopher; Presniak, Michelle D; Olson, Trevor R
Numerous authors have theorized that defense mechanisms play a role in personality disorders. We reviewed theoretical writings and empirical studies about defenses in schizotypal, borderline, antisocial, and narcissistic personality disorders, developing hypotheses about these differential relationships. We then examined these hypotheses using dynamic interview data rated for defenses in a study of participants (n = 107) diagnosed with these four personality disorder types. Overall, the prevalence of immature defenses was substantial, and all four disorders fit within the broad borderline personality organization construct. Defenses predicted the most variance in borderline and the least variance in schizotypal personality disorder, suggesting that dynamic factors played the largest role in borderline and the least in schizotypal personality. Central to borderline personality were strong associations with major image-distorting defenses, primarily splitting of self and other's images, and the hysterical level defenses, dissociation and repression. Narcissistic and antisocial personality disorders shared minor image-distorting defenses, such as omnipotence or devaluation, while narcissistic also used splitting of self-images and antisocial used disavowal defenses like denial. Overall, differential relationships between specific defenses and personality disorder types were largely consistent with the literature, and consistent with the importance that the treatment literature ascribes to working with defenses.
Riser, Rebecca E; Kosson, David S
Antisocial personality disorder (ASPD) and psychopathy are 2 important syndromes with substantial utility in predicting antisocial behavior. Although prior studies have identified correlations between various factors and the presence of psychopathy or ASPD, most studies have focused on 1 syndrome or the other. Consequently, it is unclear whether the 2 syndromes reflect similar pathophysiologies, whether they are in fact 2 distinct syndromes, or whether the correlates of ASPD reflect its high comorbidity with psychopathy. The present study addressed this issue by examining the impact of ASPD with and without comorbid psychopathy (as assessed by the Psychopathy Checklist-Revised) on criminal offending and cognitive processing in 674 adult male inmates at a county jail in Illinois. Participants exhibited either ASPD and comorbid psychopathy, ASPD but not psychopathy, or neither ASPD nor psychopathy. Participants with and without comorbid psychopathy were characterized by more criminal behavior than controls, and inmates with ASPD and psychopathy exhibited more severe criminal behavior than those with ASPD only. In addition, inmates with ASPD and psychopathy exhibited a different pattern of cognitive task performance impairment than those with ASPD alone. Results replicate the findings of Kosson, Lorenz, and Newman (2006) and provide new evidence suggesting that men with ASPD and comorbid psychopathy are characterized by cognitive processing anomalies different from those seen in ASPD without comorbid psychopathy.
Vachon, David D; Lynam, Donald R; Widiger, Thomas A; Miller, Joshua D; McCrae, Robert R; Costa, Paul T
Personality disorders (PDs) may be better understood in terms of dimensions of general personality functioning rather than as discrete categorical conditions. Personality-trait descriptions of PDs are robust across methods and settings, and PD assessments based on trait measures show good construct validity. The study reported here extends research showing that basic traits (e.g., impulsiveness, warmth, straightforwardness, modesty, and deliberation) can re-create the epidemiological characteristics associated with PDs. Specifically, we used normative changes in absolute trait levels to simulate age-related differences in the prevalence of psychopathy in a forensic setting. Results demonstrated that trait information predicts the rate of decline for psychopathy over the life span; discriminates the decline of psychopathy from that of a similar disorder, antisocial PD; and accurately predicts the differential decline of subfactors of psychopathy. These findings suggest that basic traits provide a parsimonious account of PD prevalence across the life span.
Shepherd, Stephane M; Campbell, Rachel E; Ogloff, James R P
This study identified the presence of psychopathy (as measured by the PCL-R/PCL:SV instruments) and antisocial personality disorder (APD) and their relationship with future reconviction in an Australian forensic sample (N = 136) of patients with a mental disorder. Patients were tracked for over 4 years postrelease to determine associations between a diagnosis of APD/psychopathy and reoffense. Patients with higher psychopathy scores were found to have an increased likelihood of reincarceration, a higher rate of reconviction, and were reconvicted earlier compared with patients with lower psychopathy scores. Patients with APD were more likely to be reconvicted and reincarcerated during the follow-up period than patients without an APD diagnosis. Despite demonstrating associations with general reconviction, the PCL instruments did not exhibit statistically significant relationships with violence. Implications for the clinical identification of personality disordered patients in forensic settings are discussed.
Kosson, David S; Lorenz, Amanda R; Newman, Joseph P
Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology; (b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy. Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual (4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with ASPD and psychopathy were characterized by more criminal activity than were controls. In addition, ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion facilitation than ASPD alone. Group differences in the association between emotion dysfunction and criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic features may be distinct syndromes.
Sansone, Randy A; Sansone, Lori A
Stalking, which consists of chronic nuisance behaviors by an offender that result in deleterious emotional and/or physical effects on a victim, is experienced by a significant minority of individuals in the community. According to the United States Department of Justice, eight percent of women and two percent of men have been victimized at some time in their lives by stalkers. Stalking could be viewed as an illogical or irrational preoccupation with another individual. Because of the unusual and intense attachment dynamics in borderline personality disorder, this diagnosis is particularly suggestive among stalkers. In this edition of The Interface, we examine the possible association between stalking behavior and borderline personality disorder. Five studies report prevalence rates of borderline personality disorder among stalkers, with four reporting rates between 4 and 15 percent (i.e., a small minority). However, three of these studies represent forensic populations and one consists of patients who stalked their psychiatrists. In contrast, in the remaining sample of stalkers, where being charged with a crime was not an inclusion criterion, the prevalence of borderline personality disorder was considerably higher at 45 percent. These data suggest that in less forensically focused samples of stalkers, rates of borderline personality are likely to be substantially higher, but confirmatory data is lacking.
Full Text Available Background and Objectives: Human coprophagia is a rare phenomenon with severe medical and social consequences. So far, coprophagia has mainly been associated with severe mental retardation, schizophrenia, dementia, and depression. We report a case of coprophagia in a 30-year-old woman with Borderline Personality Disorder (DSM-IV. This case report illustrates the severity of symptoms and maladaptive social consequences of severe personality disorders, comparable to those of patients with schizophrenia. Pharmacological interventions and, particularly intensive psychotherapy might be effective for patients diagnosed with borderline personality disorder displaying severe behavior disorders. The treatment of choice for coprophagia is aversive behavioral intervention.
Hyde, Luke W; Byrd, Amy L; Votruba-Drzal, Elizabeth; Hariri, Ahmad R; Manuck, Stephen B
Previous studies have emphasized that antisocial personality disorder (APD) and psychopathy overlap highly but differ critically in several features, notably negative emotionality (NEM) and possibly amygdala reactivity to social signals of threat and distress. Here we examined whether dimensions of psychopathy and APD correlate differentially with NEM and amygdala reactivity to emotional faces. Testing these relationships among healthy individuals, dimensions of psychopathy and APD were generated by the profile matching technique of Lynam and Widiger (2001), using facet scales of the NEO Personality Inventory-Revised, and amygdala reactivity was measured using a well-established emotional faces task, in a community sample of 103 men and women. Higher psychopathy scores were associated with lower NEM and lower amygdala reactivity, whereas higher APD scores were related to greater NEM and greater amygdala reactivity, but only after overlapping variance in APD and psychopathy was adjusted for in the statistical model. Amygdala reactivity did not mediate the relationship of APD and psychopathy scores to NEM. Supplemental analyses also compared other measures of factors within psychopathy in predicting NEM and amygdala reactivity and found that Factor 2 psychopathy was positively related to NEM and amygdala reactivity across measures of psychopathy. The overall findings replicate seminal observations on NEM in psychopathy by Hicks and Patrick (2006) and extend this work to neuroimaging in a normative population. They also suggest that one critical way in which APD and psychopathy dimensions may differ in their etiology is through their opposing levels of NEM and amygdala reactivity to threat.
Psychopathy and its relation to criminal behaviour has been the focus of clinical research for many years. Within the context of South African criminal law, the impact of psychopathy on criminal liability has been addressed in numerous decisions with varying outcomes all indicative of the reality that psychopathy will at most serve as a factor in mitigation of sentence, but will not exonerate an accused of criminal responsibility. In this contribution, the author reflects on the diagnostic entities of psychopathy and antisocial personality disorder against the backdrop of South African criminal law cases in terms of which either of these entities were raised in support of mitigation of sentence and/or as extenuating circumstances.
Nyström, Markus B T; Mikkelsen, Fredrik
The purpose of this study was to examine whether there is a correlation between the amount of psychopathy-related personality traits and the type of shame management in adolescents. Two hypotheses were examined; first, that there is a positive correlation between psychopathy-related personality traits and more unconscious and externalized shame management strategies, and second, that there is a negative correlation between psychopathy-related personality traits and more conscious and internalized shame management strategies. Gender differences were also examined. In total, 236 participants were available for the study. All were secondary-level students, aged 16 to 21 years. Of these, 196 were examined: 96 were male and 100 female. The study used two self-assessment forms-the Youth Psychopathic traits Inventory (YPI) and the Compass of Shame Scale (CoSS)-to measure the relevant personality characteristics. The results indicated gender differences, which led to all the analyses being conducted separately for males and females. Support was found for the study's first hypothesis, but not for the second, which was true for both males and females. Our results may have implications for the treatment of adolescents with a high percentage of psychopathy-related personality traits; they also indicate the need for more research on the association between psychopathy and shame management.
Vaidyanathan, Uma; Hall, Jason R; Patrick, Christopher J; Bernat, Edward M
Prior research has demonstrated deficits in defensive reactivity (indexed by potentiation of the startle blink reflex) in psychopathic individuals. However, the basis of this association remains unclear, as diagnostic criteria for psychopathy encompass two distinct phenotypic components that may reflect differing neurobiological mechanisms-an affective-interpersonal component and an antisocial deviance component. Likewise, the role of defensive response deficits in antisocial personality disorder (APD), a related but distinct syndrome, remains to be clarified. In the current study, the authors examined affective priming deficits in relation to factors of psychopathy and symptoms of APD using startle reflex methods in 108 adult male prisoners. Deficits in blink reflex potentiation during aversive picture viewing were found in relation to the affective-interpersonal (Factor 1) component of psychopathy, and to a lesser extent in relation to the antisocial deviance (Factor 2) component of psychopathy and symptoms of APD-but only as a function of their overlap with affective-interpersonal features of psychopathy. These findings provide clear evidence that deficits in defensive reactivity are linked specifically to the affective-interpersonal features of psychopathy and not to the antisocial deviance features represented most strongly in APD.
Patrick, Christopher J; Drislane, Laura E
The triarchic model (Patrick, Fowles, & Krueger, 2009) was formulated to reconcile contrasting conceptions of psychopathy reflected in historic writings and contemporary assessment instruments, and to address persisting unresolved issues in the field. The model conceives of psychopathy as encompassing three distinct but interrelated phenotypic dispositions--disinhibition, boldness, and meanness--with biological referents. These dispositional constructs can be viewed as building blocks for alternative conceptions of psychopathy, and various existing psychopathy measures are presumed to index these constructs to differing degrees. This article summarizes the bases of the triarchic model in the conceptual and empirical literatures on psychopathy, and it describes linkages between the constructs of the model and established structural frameworks for personality and psychological disorders. Alternative methods for indexing the constructs of the model are described, and evidence regarding their interrelations and criterion-related validity is reviewed. Promising aspects of the model for ongoing research on psychopathy are discussed, along with current gaps in knowledge/methods and recommended avenues for future research.
Drass, Jessica Masino
Art therapy has shown benefits for people with borderline personality disorder and borderline personality traits by alleviating interpersonal difficulties such as affect regulation, an unstable sense of self, self-injurious behaviors, and suicidal ideation. Borderline personality disorder is currently viewed as a trauma spectrum disorder, because…
Elzy, Meredith B.
The relationship between childhood sexual abuse and borderline personality disorder is a prominent issue in the etiological research on borderline personality disorder. This study further explored the relationship between childhood sexual abuse and the development of borderline personality features while evaluating the moderating role of a primary…
Weinberg, Anna; Klonsky, E. David; Hajcak, Greg
Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained…
Braamhorst, W.; Lobbestael, J.; Emons, W.H.M.; Arntz, A.; Witteman, C.L.M.; Bekker, M.H.J.
This study investigated sex bias in the classification of borderline and narcissistic personality disorders. A sample of psychologists in training for a post-master degree (N = 180) read brief case histories (male or female version) and made DSM classification. To differentiate sex bias due to sex s
An increasing prevalence of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) diagnoses among women illustrates problems and limitations of the medical model system. Article explores overlapping relationship between BPD and PTSD and critiques how both are viewed within the mental health community. Previous research is…
Bornovalova, Marina A.; Hicks, Brian M.; Patrick, Christopher J.; Iacono, William G.; McGue, Matt
Although large epidemiological data sets can inform research on the etiology and development of borderline personality disorder (BPD), they rarely include BPD measures. In some cases, however, proxy measures can be constructed using instruments already in these data sets. In this study, the authors developed and validated a self-report measure of…
Bandelow, Borwin; Schmahl, Christian; Falkai, Peter; Wedekind, Dirk
The neurobiology of borderline personality disorder (BPD) remains unclear. Dysfunctions of several neurobiological systems, including serotoninergic, dopaminergic, and other neurotransmitter systems, have been discussed. Here we present a theory that alterations in the sensitivity of opioid receptors or the availability of endogenous opioids…
Bui, Eric; Rodgers, Rachel; Chabrol, Henri; Birmes, Philippe; Schmitt, Laurent
Anakin Skywalker, one of the main characters in the "Star Wars" films, meets the criteria for borderline personality disorder (BPD). This finding is interesting for it may partly explain the commercial success of these movies among adolescents and be useful in educating the general public and medical students about BPD symptoms.
Bagge, Courtney; Nickell, Angela; Stepp, Stephanie; Durrett, Christine; Jackson, Kristina; Trull, Timothy J
In a sample of 351 young adults, the authors assessed whether borderline personality disorder (BPD) features prospectively predicted negative outcomes (poorer academic achievement and social maladjustment) over the subsequent 2 years, over and above gender and both Axis I and Axis II psychopathology. Borderline traits were significantly related to these outcomes, with impulsivity and affective instability the most highly associated. The present findings suggest that the impulsivity and affective instability associated with BPD leads to impairment in relating well with others, in meeting social role obligations, and in academic or occupational achievement. Therefore, these may be especially important features to target in interventions for BPD.
Wygant, Dustin B; Sellbom, Martin; Sleep, Chelsea E; Wall, Tina D; Applegate, Kathryn C; Krueger, Robert F; Patrick, Christopher J
For decades, it has been known that the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of Antisocial Personality Disorder (ASPD) is a nonadequate operationalization of psychopathy (Crego & Widiger, 2015). The DSM-5 alternative model of personality disorders provides an opportunity to rectify some of these long held concerns. The current study compared the Section III alternative model's trait-based conception of ASPD with the categorical model from the main diagnostic codes section of DSM-5 in terms of associations with differing models of psychopathy. We also evaluated the validity of the trait-based conception more broadly in relation to measures of antisocial tendencies as well as psychopathy. Participants were 200 male inmates who were administered a battery of self-report and interview-based researcher rating measures of relevant constructs. Analyses showed that Section III ASPD outperformed Section II ASPD in predicting scores on Hare's (2003) Psychopathy Checklist-Revised (PCL-R; r = .88 vs. .59). Additionally, aggregate scores for Section III ASPD performed well in capturing variance in differing ASPD and psychopathy measures. Finally, we found that the Section III ASPD impairment criteria added incrementally to the Section III ASPD traits in predicting PCL-R psychopathy and SCID-II ASPD. (PsycINFO Database Record
Miller, Joshua D; Lamkin, Joanna; Maples-Keller, Jessica L; Lynam, Donald R
The recently articulated and increasingly prominent triarchic model of psychopathy (TPM) posits the existence of 3 components of meanness, disinhibition, and boldness. In the current studies, 2 issues are addressed. First, although typically conceptualized in isolation from trait models of personality, the TPM components may be manifestations of basic personality dimensions. In Study 1 (N = 335), we test whether basic traits from the five-factor model (FFM) can account for the TPM's psychopathy domains. The FFM domains (Mean R2 = .65) and facets (Mean R2 = .75) accounted for substantial variance in the TPM domains, suggesting that the TPM can be viewed as being nested within a broader trait framework. Second, there is disagreement about which personality components are necessary and sufficient for psychopathy. In Study 2, we examine this issue using a between subject design in which expert raters (N = 46) were asked to view an FFM profile of the TPM domains and total score derived in Study 1 and rate the degree to which an individual with this profile would manifest symptoms of psychopathy, Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) personality disorders, and a variety of other psychiatric disorders. As expected, the profile associated with boldness was rated as less emblematic of psychopathy and related disorders (e.g., antisocial personality disorder; externalizing disorders) than the profiles for meanness or the total TPM score. These findings contribute to an ongoing debate addressing the degree to which domains like those articulated in the TPM are necessary or sufficient for the construct of psychopathy. (PsycINFO Database Record
Hoff, Helge Andreas; Rypdal, Knut; Hart, Stephen D; Cooke, David J; Mykletun, Arnstein
This study examines the structure of the Comprehensive Assessment of Psychopathic Personality (CAPP) from a card sort perspective. The CAPP is a lexically based construct map of psychopathy comprising 33 symptoms organized by its developers into 6 broad functional domains of personality (i.e., Attachment, Behavioral, Cognitive; Dominance; Emotional, Self). Groups of mental health workers and students were asked to sort the CAPP symptoms into the model's 6 proposed domains. Overall, both mental health workers and students were able to categorize the symptoms speedily and intuitively according to model. This suggests that the CAPP model's hierarchical structure is plausible, and that the lexical nature of the model is successful in facilitating people's ability to understand features of psychopathy in a way that requires limited cognitive effort. Together, these findings support the validity of the CAPP model as a lexically based concept map of psychopathy. Yet, some exceptions to the overall pattern of agreement with model were identified.
Blagov, Pavel S; Patrick, Christopher J; Oost, Kathryn M; Goodman, Joshua A; Pugh, Alan T
The triarchic model of psychopathy replaces a syndromal view of this pathological personality condition with a tripartite trait-based conception, positing three distinct phenotypic dispositions as building blocks for what theorists have traditionally termed psychopathy. The Triarchic Psychopathy Measure (TriPM) offers an efficient means for measuring the three dimensions to facilitate research on the model's validity. We tested the reliability of the TriPM as well as its convergent and discriminant validity with respect to differing models of personality and other criterion variables reflecting social-emotional adjustment and mental health in an undergraduate participant sample (n = 120). The TriPM evidenced excellent internal consistencies, good test-retest reliability, and strong validity consistent with the triarchic model. We discuss the results with respect to prior research and offer suggestions for future research on the validity of the TriPM and the triarchic model.
Patrick, Christopher J
This chapter reviews the existing literature on physiological correlates of psychopathy, antisocial personality disorder, and persistent violence/aggression. Coverage is provided of findings from studies utilizing peripheral, electrocortical, and neuroimaging measures. The review begins with a discussion of how psychopathy and antisocial personality are defined, and how these conditions relate to one another and to violent behavior. A case is made that the relationships psychopathy and ASPD show with violent and aggressive behavior, and similarities and differences in associations of each with physiological measures of various types can be understood in terms of symptomatic features these conditions have in common versus features that distinguish them. Following this, an overview is provided of major lines of evidence emerging from psychophysiological and neuroimaging studies conducted to date on these conditions. The final section of the chapter summarizes what has been learned from these existing studies and discusses implications and directions for future research.
Senija Tahirovic; Adela Bajric
Many studies have focused on the attachment styles and their impact on human functioning and relationships (Bretherton, 1992). Some attachment styles have been associated with pathological way of human overall functioning, and it has already been observed that insecure attachment style in childhood may be associated with personality dysfunction (Brennan & Shaver, 1998). The purpose of this study is to investigate how people diagnosed with borderline personality disorder (BPD) describe th...
Costa, Mónica Raquel Saraiva; Mota,Catarina Pinheiro; Milheiro,Cláudia
Abstract: This case study refers to the borderline personality theme shown through the life experience of a young adult woman who demonstrates inner instability and the passage to action through self-mutilation. The evaluation reveals self-fragmentation and inefficiency in the use of defense mechanisms, shown by a fragile and immature personality with low impulse control. This study was developed within the psychology consultations in the Psychology Department of Hospital Magalhães Lemos. Psy...
Jopling, Ellen N; Khalid-Khan, Sarosh; Chandrakumar, Shivani F; Segal, Shira C
With an estimated lifetime prevalence as high as 5.9% in the general population, borderline personality disorder (BPD) is a psychiatric disorder characterized by marked impulsivity as well as difficulties in interpersonal relationships, self-image, and affects. The burden on the health care system is immense with BPD patients accounting for 10%-20% of the patients in mental health outpatient facilities and 15%-40% in mental health inpatient facilities. Further, while 75%-80% of BPD patients attempt to commit suicide, 10% succeed; this mortality rate exceeds even that of anorexia nervosa which, with a weighted mortality rate of 5.1%, has often been considered to have the highest mortality rate of any mental disorder. In order to provide treatment and to implement preventative measures, a risk profile as well as clinical features must be identified within the adolescent population. This is presently crucial, as the current criteria for BPD are not developmentally focused, and as a result, criteria initially developed for the adult population are being applied in diagnoses of adolescents. A population of adolescents (n=80) between 16 and 19 years of age meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria either for BPD traits (n=46) or for BPD (n=36) were included in a retrospective chart review; a control group consisting of n=30 mood and anxiety control subjects were included to allow for further comparisons. Complex significant differences were discovered between the three groups in the following areas: history of sexual abuse, suicidal ideation, internalizing/externalizing symptoms, interpersonal difficulties, impulsivity, pre-perinatal stress, bullying, substance abuse, anxiety disorders, disruptive disorders, and finally, learning disorders.
Sylvers, Patrick; Landfield, Kristin E.; Lilienfeld, Scott O.
Objective: This study extends the college heavy episodic drinking literature by examining the associations between features of psychopathy and antisocial personality disorder (ASPD), on the one hand, and heavy episodic drinking and associated problem behaviors, on the other. Participants: Participants were 159 (85 male, 74 female) undergraduates…
Self-identity is disrupted in people with borderline personality disorder (BPD) and depersonalization disorder (DPD), fluctuating with sudden shifts in affect in BPD and experienced as detached in DPD. Measures of implicit self-esteem, free from conscious control and presentation biases, may highlight how such disruptions of self-concept differentially affect these two populations on an unconscious level. We examined implicit self-esteem using the Implicit Association Test, along with measure...
Full Text Available Background: In a psychodynamic pers-pective, one of the essential aspects of borderline personality is the insufficient self integration, which often results in a poor relation with the body and self-destructive behaviours.Aims: We intend to approach self development in borderline personality, understand the importance of the body in its development, as well as the role of self-mutilating behaviour in the relationship between self and body.Methods: Non systematic literature review based on Otto Kernberg and Didier Anzieu theories.Results and Conclusions: On the one hand, we find that in borderline personality splitting remains the predominant defence mechanism, preventing proper differentia-tion between self and object, as well as the integration of good and bad aspects of self and object. Moreover, the concept of “skin-ego”, defined by Didier Anzieu, says that the tactile sensibility is an Ego and thought or-ganizing model and, in borderline personality, the development of this body envelope is severely compromised. Self-mutilation is, simultaneously, an attempt to re-establish the boundaries of self and a communication type open to intersubjectivity that, although contains a destructive aspect, enables self repair.
De Moor, Marleen H. M.; Distel, Marijn A.; Trull, Timothy J.; Boomsma, Dorret I.
Borderline personality disorder (BPD) is more often diagnosed in women than in men, and symptoms tend to decline with age. Using a large community sample, the authors investigated whether sex and age differences in four main features of BPD, measured with the "Personality Assessment Inventory-Borderline Features" scale (PAI-BOR; Morey,…
Petermann, F; Remschmidt, H
Personality disorders manifest themselves in stable deviations of personality traits that especially arise in negative interactions with others. Those typical dysfunctional interactions can be observed particularly in dissocial and antisocial personality disorders: adults with severe forms of personality disorders often showed specific symptoms in childhood and adolescence. Clinical researchers therefore demand a respective diagnosis of childhood and adolescent psychopathy. There is an extensive body of research on dissocial and borderline personality disorders in children and adolescents. To date the severe form of dissocial personality disorders, psychopathy, cannot be specifically classified. The transfer of this diagnosis to childhood and adolescence is crucial: based on the assumption of persistence and the risk of stigmatisation many clinicians refuse to diagnose psychopathy at a young age. On the other hand there are positive treatment outcomes that aim at symptom reduction from a very early age. The specification of dissocial personality disorders in childhood and adolescence may encourage the development of new treatments and the de-stigmatisation as well as qualify the dogged assumption of persistence of personality disorders.
Miller, Audrey K.; Rufino, Katrina A.; Boccaccini, Marcus T.; Jackson, Rebecca L.; Murrie, Daniel C.
This study investigated raters' personality traits in relation to scores they assigned to offenders using the Psychopathy Checklist-Revised (PCL-R). A total of 22 participants, including graduate students and faculty members in clinical psychology programs, completed a PCL-R training session, independently scored four criminal offenders using the…
Ross, Colin A; Ferrell, Lynn; Schroeder, Elizabeth
The literature indicates that, among individuals with borderline personality disorder, pathological dissociation correlates with a wide range of impairments and difficulties in psychological function. It also predicts a poorer response to dialectical behavior therapy for borderline personality disorder. We hypothesized that (a) dissociative identity disorder commonly co-occurs with borderline personality disorder and vice versa, and (b) individuals who meet criteria for both disorders have more comorbidity and trauma than individuals who meet criteria for only 1 disorder. We interviewed a sample of inpatients in a hospital trauma program using 3 measures of dissociation. The most symptomatic group was those participants who met criteria for both borderline personality disorder and dissociative identity disorder on the Dissociative Disorders Interview Schedule, followed by those who met criteria for dissociative identity disorder only, then those with borderline personality disorder only, and finally those with neither disorder. Greater attention should be paid to the relationship between borderline personality disorder and dissociative identity disorder.
Verona, Edelyn; Sprague, Jenessa; Sadeh, Naomi
The field of personality disorders has had a long-standing interest in understanding interactions between emotion and inhibitory control, as well as neurophysiological indices of these processes. More work in particular is needed to clarify differential deficits in offenders with antisocial personality disorder (APD) who differ on psychopathic traits, as APD and psychopathy are considered separate, albeit related, syndromes. Evidence of distinct neurobiological processing in these disorders would have implications for etiology-based personality disorder taxonomies in future psychiatric classification systems. To inform this area of research, we recorded event-related brain potentials during an emotional-linguistic Go/No-Go task to examine modulation of negative emotional processing by inhibitory control in three groups: psychopathy (n = 14), APD (n = 16), and control (n = 15). In control offenders, inhibitory control demands (No-Go vs. Go) modulated frontal-P3 amplitude to negative emotional words, indicating appropriate prioritization of inhibition over emotional processing. In contrast, the psychopathic group showed blunted processing of negative emotional words regardless of inhibitory control demands, consistent with research on emotional deficits in psychopathy. Finally, the APD group demonstrated enhanced processing of negative emotion words in both Go and No-Go trials, suggesting a failure to modulate negative emotional processing when inhibitory control is required. Implications for emotion-cognition interactions and putative etiological processes in these personality disorders are discussed.
Warren, Janet I; South, Susan C
Our study examines the relationship between Antisocial Personality Disorder (APD) and psychopathy among a sample of 137 female offenders. Drawing from a historical review of the evolution of these two concepts, we explore their differential relationship to patterns of criminal behavior, psychological adjustment, co-morbidity with other personality disorders, victimization, and institutional adjustment. Findings suggest that the two disorders share a common foundation of social norm violations and deception; however, APD is associated with impulsive, aggressive, and irresponsible behavior, higher rates of childhood abuse, and greater co-morbidity with Cluster A PDs, while psychopathy is better characterized by higher rates of property crimes, previous incarceration, and the manifestation of remorselessness. Results contribute to a further understanding of the etiology and phenomenology of these two disorders and suggest different types of treatment and intervention.
From the findings obtained by means of the interviews of women living with borderline personality disorder, it was evident that there were childhood experiences of living in an unsafe space, related to unhealthy family dynamics, boundary violations and educational challenges. They experienced chronic feelings of emptiness in their relationships with the self. They also presented with a pattern of unstable interpersonal relationships and compromised mental health, which was apparent through the early onset of mental problems, emotional upheaval, looking for emotional escape and having different trigger factors. Lastly, all these women yearned for facilitated mental health.
Lauer, J; Black, D W; Keen, P
We report data from a comparison of 14 subjects with multiple personality disorder (MPD) and 13 subjects with borderline personality disorder (BPD). There were few significant differences between the groups. The authors discuss the concept of MPD as an epiphenomenon of BPD, and argue their fundamental similarity.
Hooley, Jill M; Wilson-Murphy, Molly
Borderline personality disorder (BPD) is characterized by tumultuous, unstable personal relationships, difficulty being alone, and an inability to self-soothe. This may explain why patients with BPD tend to develop strong attachments to transitional objects such as stuffed animals. Research in hospital settings has linked the use of transitional objects to the presence of BPD. Using a nonclinical community sample (N = 80) we explored the link between attachments to transitional objects and various aspects of personality pathology, as well as to childhood trauma, and parental rearing styles. People who reported intense current attachments to transitional objects were significantly more likely to meet criteria for a BPD diagnosis than those who did not; they also reported more childhood trauma, rated their early caregivers as less supportive, and had more attachment problems as adults. Heavy emotional reliance on transitional objects in adulthood may be an indicator of underlying pathology, particularly BPD.
This article describes a conceptual framework for describing borderline personality disorder (BPD) based on empirical studies of the phenotypic structure and genetic architecture of personality. The proposed phenotype has 2 components: (1) a description of core self and interpersonal pathology-the defining features of personality disorder-as these features are expressed in the disorder; and (2) a set of traits based on the anxious-dependent or emotional dysregulation factor of the four-factor model of PD. Four kinds of traits are described: emotional (anxiousness, emotional reactivity, emotional intensity, and pessimistic-anhedonia), interpersonal (submissiveness, insecure attachment, social apprehensiveness, and need for approval), cognitive (cognitive dysregulation), and self-harm (behaviors and ideas). Formulation of the phenotype was guided by the conceptualization of personality as a system of interrelated sub-systems. The psychopathology associated with BPD involves most components of the system. The trait structure of the disorder is assumed to reflect the genetic architecture of personality and individual traits are assumed to be based on adaptive mechanisms. It is suggested that borderline traits are organized around the trait of anxiousness and that an important feature of BPD is dysregulation of the threat management system leading to pervasive fearfulness and unstable emotions. The interpersonal traits are assumed to be heritable characteristics that evolved to deal with interpersonal threats that arose as a result of social living. The potential for unstable and conflicted interpersonal relationships that is inherent to the disorder is assumed to result from the interplay between the adaptive structure of personality and psychosocial adversity. The etiology of the disorder is discussed in terms of biological and environmental factors associated with each component of the phenotype.
Ogłodek, Ewa; Araszkiewicz, Aleksander
The history of the development of the concept of borderline personality disorder dates back to the late nineteenth century when in 1884 described the first cases of patients with a clinical picture similar to today's concept of borderline personality disorder, using the first time the concept of borderline. On the current understanding of the borderline personality disorder had a significant impact available and valid diagnostic criteria included in the classifications ICD-10 and DSM-IV-TR and psychological theories such as psychoanalytic theory of "object relations" and cognitive behavioral approaches.
Tragesser, Sarah L; Benfield, Jacob
The purpose of the present study was to examine the association between features of borderline personality disorder (BPD) and mate retention tactics as a means of examining an evolutionary perspective on the association between BPD features and interpersonal problems and violence in romantic relationships. Two-hundred twenty-five college student participants completed the Personality Assessment Inventory for Borderlines (PAI-BOR; Morey, 1991) and the Mate Retention Inventory-Short Form (MRI-SF; Buss, Shackelford, & McKibbin, 2008) embedded within other measures. There was a strong association between BPD features and cost-inflicting mate retention tactics, including the specific tactics of vigilance, punishing mate's infidelity threat, intrasexual threats, and sexual inducements for both men and women. There were also gender-specific associations for additional tactics. These results contribute to our understanding of problems in romantic relationships among men and women with BPD features, including violence, and to our understanding of impulsive sexual behavior among individuals with BPD features by showing how these behaviors are used as extreme, maladaptive attempts at mate retention.
Anderson, Jaime L; Sellbom, Martin; Wygant, Dustin B; Salekin, Randall T; Krueger, Robert F
The current investigation examined the associations between personality traits representing DSM-5 Section III Antisocial Personality Disorder (ASPD), its psychopathy specifier, and contemporary models of psychopathic personality disorder. We used two samples consisting of university students (n = 463) and community-dwelling participants (n = 148) recruited for subclinical psychopathic proclivities. Both samples were administered the Personality Inventory for DSM-5 (Krueger et al., 2012), Triarchic Psychopathy Measure (Patrick, 2010), and versions of the Psychopathic Personality Inventory (PPI; Lilienfeld & Widows, 2005). University students also completed the Structured Clinical Interview for DSM-IV Axis II Disorders-Personality Questionnaire (First, Gibbon, Spitzer, Williams, & Benjamin, 1997). Across both samples, the Section III ASPD traits were moderately strongly correlated with psychopathy measures, except the fearless-dominance/boldness domain. However, as would be expected, traits representing the Section III psychopathy specifier accounted for a substantial amount of variance within this domain. Furthermore, additional DSM-5 Section III personality traits augmented the characterization of psychopathy from the PPI and Triarchic perspectives.
Full Text Available In this article the author examines some significant passages of his treatment of a patient with borderline personality structure, with the intention of giving a formative contribution to the delicate issue of the search for congruence between theory and clinic operations. This reflection is therefore an opportunity to integrate these aspects. The individualization of the therapeutic relationship in the theoretical framework of group analysis allowed the emotional investment in the person of the therapist, which is useful in the construction of a meaningful relationship on the human, emotional and cognitive plane; a space within which it has become increasingly possible for Sara, share and process emotions, re-build, contact parts of the self frustrated and disappointed, perceive less and less the void and become less vulnerable, being able to pull over to the original trauma.
Specht, Matt W; Chapman, Alex; Cellucci, Tony
There is increasing interest regarding the role of maladaptive cognition in Borderline Personality Disorder (BPD). The current study examined the relationship between early maladaptive schema (EMS) domains and BPD symptoms as well as whether schema domains account for the relationship between childhood maltreatment and BPD severity. Incarcerated women (N=105) were assessed for BPD symptoms via semi-structured diagnostic interview. Disconnection/Rejection and Impaired Limits were associated with BPD pathology although these domains shared variance with depression and antisocial personality disorder pathology, respectively. In addition, the relationship between childhood abuse and BPD severity was non-significant after controlling for schema domains. Related findings and the implications for cognitive treatment of BPD are discussed.
Stringer, Barbara; Meijel, Berno van; Eikelenboom, M.; Koekkoek, B.; Licht, C.; Kerkhof, A.J.; Penninx, B.W.; Beekman, A.T.
Background The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Method
Stringer, Barbara; van Meijel, Berno; Eikelenboom, Merijn; Koekkoek, Bauke; Licht, Carmilla M. M.; Kerkhof, Ad J. F. M.; Penninx, Brenda W. J. H.; Beekman, Aartjan T. F.
Background: The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Method
Full Text Available Many studies have focused on the attachment styles and their impact on human functioning and relationships (Bretherton, 1992. Some attachment styles have been associated with pathological way of human overall functioning, and it has already been observed that insecure attachment style in childhood may be associated with personality dysfunction (Brennan & Shaver, 1998. The purpose of this study is to investigate how people diagnosed with borderline personality disorder (BPD describe their attachment style to the primary caregivers from their memories from childhood. This study was conducted in Germany in an inpatient psychiatric clinic. Fifteen participants represented a convenience sample, of patients already diagnosed with BPD. For this study Adult Attachment Interview (AAI was used. The AAI is a semi-structured interview focusing on the early attachment experiences and their effects based on Attachment Theory.The results indicated that people diagnosed with BPD showed both preoccupied and dismissing child-parent attachment style,however it was the dismissing attachment style that dominated in our sample. The findings supported the hypothesis that participants who showed dismissing attachment style also used positive adjectives to describe the relationship with their primary caregiver, and those with the preoccupied attachment style used negative adjectives to describe the relationship with their primary caregiver. Even though, study was conducted with small number of participants, the study did provide evidence that there is a relationship between BPD and attachment styles in childhood. Threfore, the study offered contribution to the already existing knowledge and research findings regarding the influence of attachment style on BPD development. Keywords: Attachment, Personality disorder, Borderline Personality Disorder (BPD, child, childhood
Kuritárné Szabó, Ildikó
In the last 20 years six psychotherapy methods have been developed specifically for borderline personality disorder. Solid RCT evidences suggests the efficacy of all the methods. Roughly equivalent improvement was obtained from the different types of psychotherapies. Today we have reached a new phase of the borderline "psychotherapy boom", the integrative approach. According to the integrative treatment advocates we should not choose among these effective treatments but we can incorporate in the therapy all the components that work. The integrative approach uses general factors common to all effective therapies, combined with specific treatment techniques taken from different therapies in order to treat the given patient's psychopathology. These common factors are: coherent framework; attention to strategies for building strong positive alliance and maintaining patient motivation; creating a safe and structured therapeutic environment; clear treatment frame; transparency of the goals and roles; focus upon presenting problems; higher level therapeutic activity; here-and-now focus; and facilitating self-reflection. Treatment focuses on change while maintaining a validating and supportive stance. General strategies can be supplemented by more specific techniques such as cognitive-behavioral interventions for reducing maladaptive behavior, training for developing emotion regulation skills and interpersonal skills coming from dialectical behavior therapy. Methods drawn from psychodynamic approaches can be used for the modification of underlying interpersonal cognitive-emotional schemas.
Gratz, Kim L.; Latzman, Robert D.; Tull, Matthew T.; Reynolds, Elizabeth K.; Lejuez, C. W.
Most of the extant literature on borderline personality disorder has focused on the course, consequences, and correlates of this disorder among adults. However, little is known about childhood borderline personality (BP) features, or the factors associated with the emergence of BP pathology in childhood. A greater understanding of childhood BP…
Patients with borderline personality disorder are frequent users of inpatient mental health units, with inpatient crisis intervention often used based on the risk of suicide. However, this can present an ethical dilemma for nursing and medical staff, with these clinician responses shifting between the moral principles of beneficence and non-maleficence, dependent on the outcomes of the actions of containing or tolerating risk. This article examines the use of crisis intervention through moral duties, intentions and consequences, culminating in an action/consequence model of risk management, used to explore potential outcomes. This model may be useful in measuring adherence and violation of the principles of beneficence and non-maleficence and therefore an aid to clinical decision making.
Borderline personality disorder (BPD) is a common psychiatric disorder associated with severe functional impairment, high rates of suicide and comorbid psychiatric illness, intensive use of treatment, and high costs to society. The etiology and pathogenesis of BPD are still uncertain, although an interaction between biological and psychosocial factors has been proposed to explain how the condition develops. Attachment disturbances represent one of the developmental risk factors that have been most consistently found to be associated with BPD, with a number of studies reporting a significant strong association between insecure attachment and BPD, notwithstanding the variety of measures and attachment types employed in these studies. In this article, the author first reviews clinical descriptions and research findings concerning the association between attachment disturbances and BPD and then discusses how attachment theory may help clinicians who work with patients with BPD better understand the psychopathology of the illness and plan treatment.
Badoud, Deborah; Prada, Paco; Nicastro, Rosetta; Germond, Charlotte; Luyten, Patrick; Perroud, Nader; Debbané, Martin
Insecure attachment and impairments in reflective functioning (RF) are thought to play a critical role in borderline personality disorder (BPD). In particular, the mentalization-based model argues that insecure attachment indirectly accounts for increased BPD features, notably via disruption of RF capacities. Although the mediation relationship between attachment, RF, and BPD is supported by previous evidence, it remains to be directly tested in adults with BPD. In the current study, a sample of 55 female adult BPD patients and 105 female healthy controls completed a battery of self-report measures to investigate the interplay between attachment, RF capacities, and BPD clinical status. Overall, the results showed that BPD patients predominantly reported insecure attachment, characterized by negative internal working models of the self as unlovable and unimportant to others, and decreased RF abilities. Our findings further indicated that actual RF capacities mediated the relationships between adult insecure attachment and BPD clinical status.
Sharp, Carla; Kim, Sohye
The aim of the current paper was to review the most recent advances in the developmental aspects of borderline personality disorder (BPD) over the last 3 years to highlight the most significant trends in the field. In so doing, we identify and discuss two exciting new trends: (a) an emphasis on the biological basis of adolescent BPD and (b) empirical evidence in support of long-held theories of the development of BPD. Together, these trends suggest that for the first time, empirical findings are beginning to emerge in support of complex and reciprocal biology × environment interactions over time in the development of BPD. We discuss the emerging literature and highlight the translational impact of this work for the assessment and intervention of adolescent BPD.
Scott, Lori N.; Levy, Kenneth N.; Pincus, Aaron L.
Previous studies have demonstrated that insecure attachment patterns and a trait disposition toward negative affect and impulsivity are both associated with borderline personality disorder (BPD) features. According to attachment theory, insecure attachment patterns impart greater risk for the maladaptive personality traits underlying BPD. Hence, insecure attachment might be indirectly related to BPD through its association with these traits. The current cross-sectional study used structural e...
Belli, Hasan; Ural, Cenk; Akbudak, Mahir
In this article, it is aimed to review the efficacies of mood stabilizers and atypical antipsychotics, which are used commonly in psychopharmacological treatments of bipolar and borderline personality disorders. In this context, common phenomenology between borderline personality and bipolar disorders and differential features of clinical diagnosis will be reviewed in line with the literature. Both disorders can demonstrate common features in the diagnostic aspect, and can overlap phenomenologically. Concomitance rate of both disorders is quite high. In order to differentiate these two disorders from each other, quality of mood fluctuations, impulsivity types and linear progression of disorders should be carefully considered. There are various studies in mood stabilizer use, like lithium, carbamazepine, oxcarbazepine, sodium valproate and lamotrigine, in the treatment of borderline personality disorder. Moreover, there are also studies, which have revealed efficacies of risperidone, olanzapine and quetiapine as atypical antipsychotics. It is not easy to differentiate borderline personality disorder from the bipolar disorders. An intensively careful evaluation should be performed. This differentiation may be helpful also for the treatment. There are many studies about efficacy of valproate and lamotrigine in treatment of borderline personality disorder. However, findings related to other mood stabilizers are inadequate. Olanzapine and quetiapine are reported to be more effective among atypical antipsychotics. No drug is approved for the treatment of borderline personality disorder by the entitled authorities, yet. Psychotherapeutic approaches have preserved their significant places in treatment of borderline personality disorder. Moreover, symptom based approach is recommended in use of mood stabilizers and atypical antipsychotics.
Hecht, Kathryn F; Cicchetti, Dante; Rogosch, Fred A; Crick, Nicki R
Child maltreatment has been established as a risk factor for borderline personality disorder (BPD), yet few studies consider how maltreatment influences the development of BPD features through childhood and adolescence. Subtype, developmental timing, and chronicity of child maltreatment were examined as factors in the development of borderline personality features in childhood. Children (M age = 11.30, SD = 0.94), including 314 maltreated and 285 nonmaltreated children from comparable low socioeconomic backgrounds, provided self-reports of developmentally salient borderline personality traits. Maltreated children had higher overall borderline feature scores, had higher scores on each individual subscale, and were more likely to be identified as at high risk for development of BPD through raised scores on all four subscales. Chronicity of maltreatment predicted higher overall borderline feature scores, and patterns of onset and recency of maltreatment significantly predicted whether a participant would meet criteria for the high-risk group. Implications of findings and recommendations for intervention are discussed.
Farid Hoseini F; Asadi SM; Kaviani H; Ali Malayeri N
"nBackground: The Temperament and Character Inventory (TCI) efficiently diagnoses personality disorders, differentiating the individual subtypes. This research aimed to evaluate personality dimensions using the Cloninger TCI (TCI-125) in a group of people with borderline personality disorders at Ruzbeh Hospital, Tehran, Iran. "nMethods: In this descriptive cross-sectional study, 27 borderline personality patients were evaluated with a clinical interview based on the Diagnostic and S...
Stone, Michael H
Borderline Personality Disorder (BPD) has been defined as a personality disorder in all editions of DSM since 1980; namely, DSM III through V. The criteria are a mixture of symptoms and traits; the etiology, a heterogeneous array of genetic, constitutional, and environmental factors. Until recently the diagnosis relied on clinical descriptions. In the last two decades, neurophysiological data, including MRI and fMRI, have established correlates in various brain regions, particularly those involving the frontal lobes and various limbic structures, that show promise of providing a more substantial basis for diagnosis-relying primarily on (internal) brain changes, rather than on (external) clinical observation. Some of the changes in BPD consist of decreased volume in the orbitofrontal and dorsolateral prefrontal cortices and smaller volume in both the amygdala and hippocampus, though with heightened reactivity in the amygdala. Similar abnormalities have been noted in bipolar disorders (BDs) and in ADHD, both of which often accompany BPD and share certain clinical features. Persons with strong genetic predisposition to BDs can develop BPD even in the absence of adverse environmental factors; those with extreme adverse environmental factors (chiefly, early sexual molestation) can develop BPD in the absence of bipolar vulnerability. In some BPD patients, both sets of factors are present. As ideal treatment depends on careful analysis of these factors, neurophysiological testing may permit both more rational, brain-based diagnostic decisions and more appropriate therapeutic strategies.
Schuppert, H. Marieke; Timmerman, Marieke E.; Bloo, Josephine; van Gemert, Tonny G.; Wiersema, Herman M.; Minderaa, Ruud B.; Emmelkamp, Paul M. G.; Nauta, Maaike H.
Objective: To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group training for adolescents with borderline personality disorder (BPD) symptoms. Method: One hundred nine adolescents with borderline traits (73% meeting the full criteria for BPD) were randomized t
Full Text Available Background and Objectives: There is a growing body of evidence suggesting the role of childhood abuse in the etiology of borderline personality disorder (BPD. Studies found that complex traumatization related to BPD include emotional/physical/sexual abuse and neglect. This study examines self-reported experiences of childhood traumatization in Hungarian inpatients with a diagnosis of borderline personality disorder and reveal which etiological factors are most strongly associated with the development of BPD. Methods: Traumatic childhood experiences of 80 borderline inpatients, 73 depressed inpatients and 51 healthy controls were assessed with the Traumatic Antecedents Questionnaire and the Sexual Abuse Scale of Early Trauma Inventory. Results: Adverse childhood experiences (neglect, emotional abuse, physical abuse, sexual abuse, witnessing trauma were more prevalent among borderline patients than among depressed and healthy controls. Borderline patients reported severe sexual abuse, characterized by incest, penetration and repetitive abuse. Sexually abused borderline patients experienced more physical and emotional abuse than borderlines who were not sexually abused. The strongest predictors of borderline diagnosis were sexual abuse, intrafamilial physical abuse and neglect by the caretakers. Conclusions: Overall, our results suggest that a reported childhood history of abuse and neglect are both common and highly discriminating for borderline patients in Hungary as well.
Hoff, Paul; Camenisch, Paul
The issue of personality disorders addresses fundamental questions of psychiatry: Is there a clear boundary between normal behaviour and the state of mental illness? Which criteria are defining this boundary? Is a personality disorder really a mental illness or «just» a special variation of an individual lifestyle? This paper reviews the development of the terms psychopathy/personality disorder from the early 19th century to the present-day diagnostic manuals ICD-10 and DSM-5. This debate spreads out–as it does with regard to any other mental disorder–between psychopathological, neurobiological and social sciences approaches. It is of high practical relevance to realize that nowadays effective therapeutic options for patients with personality disorders are available. Therefore, the therapeutic nihilism of earlier times is no longer justified.
Witt, O; Brücher, K; Biegel, G; Petermann, F; Schmidt, S
The present study focuses on selected symptom criteria to distinguish between attention deficit/hyperactivity disorder (ADHD) in adults and borderline personality disorder (BPD). A sample of n = 158 subjects was examined, consisting of BPD patients (n = 37), ADHD patients (n = 58), comorbid BPD/ADHD patients (n = 19), a clinical group of patients fulfilling the diagnostic criteria of a depressive disorder (DEP; n = 22) and a non-clinical control group (KG; n = 22). Selected symptom criteria were investigated by using the German scales "Skala zur Erfassung der Impulsivität und emotionalen Dysregulation der Borderline-Persönlichkeitsstörung" (IES-27), "ADHS-Screening für Erwachsene" (ADHS-LE), "Fragebogen zu dissoziativen Symptomen" (FDS) and a scale for the assessment of paranoid and dichotomous thinking (PADI). Multivariate analyses of variance revealed that BPD patients differed significantly with respect to self-mutilating behaviour, suicidality, dissociation, paranoia and dichotomy from all other groups. The same effect was found for affect regulation. Furthermore BPD patients differed significantly from ADHD patients by a more severe impulsiveness (IES-27), but not through disturbed impulse control and disinhibition overall. Regarding mean differences between ADHD and BPD patients for attentional control, ADHD patients revealed higher scores which just missed significance. For hyperactivity no significant group differences were found which is assumed to be influenced by symptom overlap like restlessness and aversive tension. The findings suggest that BPD-specific criteria, a stronger affective dysregulation and a higher tendency for autoaggressive impulsive reactions are more selective for differential diagnosis than the core symptoms of adult ADHD. Only attentional control might be a useful criterion for differential diagnosis, which should be examined in future studies.
Jessy G. Dévieux
Full Text Available Problem statement: Incarcerated youth with borderline symptomatology represent a particularly at risk-population due to their enggement in risky behaviors. Five hundred twenty two adolescents were assessed for borderline symptomatology (MACI, engagement in risky behaviors and attitudes/knowledge. Approach:Adolescents were divided into two groups: low borderline (below the 60 scale score cutoff and high borderline (subclinical and clinical range. Multivariate analyses were used to test for group differences. Results: The high borderline group had higher perceived susceptibility, greater knowledge, less favorable sexual and condom attitudes and less favorable behavioral intentions. There were no significant differences by group on sexual risk or substance use behaviors. A subset (n = 156 participating in a risk reduction experimental trial were followed three months post-intervention for differences in sexual risk and substance use. The high borderline experimental participants reported significantly more anal sex than the low borderline adolescents at 3 month follow-up. High borderline adolescents in the control group reported greater cocaine use than low borderline controls at 3 months, including trends suggesting more marijuana and alcohol use. At 3 month follow-up, no differences in cocaine, alcohol or marijuana use were detected between high and low borderline adolescents in the experimental group. Adolescents with higher borderline tendencies appear to realistically assess that they are at high risk of contracting HIV but may have less confidence in their ability to adopt HIV preventive behaviors. The results indicate that borderline personality symptoms may represent an important indicator of attitudes conducive to HIV transmission. Conclusion:Three-month follow-up data indicate the importance of examining borderline characteristics more microanalytically within research studies, including
Full Text Available The objective of this study was to examine the relations between psychopathy - as assessed by ratings (PCL-R and by self-report (SRP3 - on one side, and The Five-Factor personality Model - expanded to include the traits Amorality and Disintegration - on the other. Both methods examined four traits of psychopathy: interpersonal, affective, lifestyle and antisocial characteristics. Data were collected on a sample of 112 male convicts. The results show the absence of congruence between the two methods - self-report and rating - in case of interpersonal and affective psychopathic dispositions. This incongruence is also reflected in their relations with personality traits. The self-report measures and the ratings of Lifestyle and Antisocial tendencies are related to amorality, aggressiveness, schizotypy, Neuroticism and impulsivity. However, the ratings of affective and interpersonal style are related to the integrated, organized, and emotionally stable aspects of personality. The results are interpreted in the light of differences between the methods of assessment and in the light of the essential characteristics of the psychopathic phenomena.
Clarke, Stephanie B.; Rizvi, Shireen L.; Resick, Patricia A.
Many studies report that comorbid borderline personality pathology is associated with poorer outcomes in the treatment of Axis I disorders. Given the high rates of comorbidity between borderline personality pathology and posttraumatic stress disorder (PTSD), it is essential to determine whether borderline symptomatology affects PTSD treatment…
Sörman, Karolina; Edens, John F; Smith, Shannon Toney; Svensson, Olof; Howner, Katarina; Kristiansson, Marianne; Fischer, Håkan
Assessments of psychopathic traits are used on a routine basis in forensic evaluations across Westernized countries. Despite this, consensus has not yet emerged concerning what exactly are the "core" features of this construct. Moreover, relatively little is known about how practitioners in the field construe this disorder. This study explored perceptions and attitudes regarding psychopathy among individuals working in the forensic mental health system (N = 90) in Sweden. Participants provided prototype ratings of what they considered to be core psychopathy features based on the Comprehensive Assessment of Psychopathic Personality (CAPP), a model that increasingly is the focus of research in North America and Europe. The study protocol also included questions regarding (a) global perceptions and attitudes about a number of aspects of the psychopathy construct (e.g., personal experience, perceived prevalence), and (b) attitudinal scales that assessed perceived correlates of psychopathic traits across a variety of domains (e.g., violence proneness, treatment amenability) and moral judgments and attitudes concerning how psychopathic offenders should be treated within the legal system. The majority of the 33 individual CAPP items and the six CAPP scales were rated as at least moderately prototypical of psychopathy, with Dominance, Self, and Attachment domains obtaining the highest mean ratings. Participants viewed psychopaths as more likely to commit crimes than the average criminal, without being blatantly "evil" people. We believe our results help to advance our understanding of the psychopathy construct by exploring forensic professionals' perceptions of this disorder in general and in relation to the CAPP model specifically.
Moor, de M.H.M.; Distel, M.A.; Trull, T.J.; Boomsma, D.I.
Borderline personality disorder (BPD) is more often diagnosed in women than in men, and symptoms tend to decline with age. Using a large community sample, the authors investigated whether sex and age differences in four main features of BPD, measured with the Personality Assessment Inventory-Borderl
Raynal, Patrick; Chabrol, Henri
The aim of the study was to examine the association of schizotypal and borderline personality traits to cannabis use. Participants were 476 college students (95 males; 381 females; mean age of males=21; mean age of females=20.7) who completed self-report questionnaires assessing cannabis use, schizotypal and borderline personality traits. Problematic cannabis use, depressive symptoms, borderline and schizotypal traits were significantly inter-correlated. A logistic regression analysis showed that only borderline traits contributed significantly to cannabis use in the total sample. A multiple regression analysis showed that only schizotypal traits were positively and uniquely associated to problematic cannabis use symptoms among users. These results may imply that schizotypal traits are not a risk factor for initiating use, but may facilitate the development of problematic use symptoms among users. This study showed the necessity of taking into account schizotypal traits when exploring the relationships between depressive symptoms, borderline traits and cannabis use.
Belsky, Daniel W; Caspi, Avshalom; Arseneault, Louise; Bleidorn, Wiebke; Fonagy, Peter; Goodman, Marianne; Houts, Renate; Moffitt, Terrie E
It has been reported that borderline personality related characteristics can be observed in children, and that these characteristics are associated with increased risk for the development of borderline personality disorder. It is not clear whether borderline personality related characteristics in children share etiological features with adult borderline personality disorder. We investigated the etiology of borderline personality related characteristics in a longitudinal cohort study of 1,116 pairs of same-sex twins followed from birth through age 12 years. Borderline personality related characteristics measured at age 12 years were highly heritable, were more common in children who had exhibited poor cognitive function, impulsivity, and more behavioral and emotional problems at age 5 years, and co-occurred with symptoms of conduct disorder, depression, anxiety, and psychosis. Exposure to harsh treatment in the family environment through age 10 years predicted borderline personality related characteristics at age 12 years. This association showed evidence of environmental mediation and was stronger among children with a family history of psychiatric illness, consistent with diathesis-stress models of borderline etiology. Results indicate that borderline personality related characteristics in children share etiological features with borderline personality disorder in adults and suggest that inherited and environmental risk factors make independent and interactive contributions to borderline etiology.
BELSKY, DANIEL W.; CASPI, AVSHALOM; ARSENEAULT, LOUISE; BLEIDORN, WIEBKE; FONAGY, PETER; GOODMAN, MARIANNE; HOUTS, RENATE; MOFFITT, TERRIE E.
It has been reported that borderline personality related characteristics can be observed in children, and that these characteristics are associated with increased risk for the development of borderline personality disorder. It is not clear whether borderline personality related characteristics in children share etiological features with adult borderline personality disorder. We investigated the etiology of borderline personality related characteristics in a longitudinal cohort study of 1,116 pairs of same-sex twins followed from birth through age 12 years. Borderline personality related characteristics measured at age 12 years were highly heritable, were more common in children who had exhibited poor cognitive function, impulsivity, and more behavioral and emotional problems at age 5 years, and co-occurred with symptoms of conduct disorder, depression, anxiety, and psychosis. Exposure to harsh treatment in the family environment through age 10 years predicted borderline personality related characteristics at age 12 years. This association showed evidence of environmental mediation and was stronger among children with a family history of psychiatric illness, consistent with diathesis–stress models of borderline etiology. Results indicate that borderline personality related characteristics in children share etiological features with borderline personality disorder in adults and suggest that inherited and environmental risk factors make independent and interactive contributions to borderline etiology. PMID:22293008
J.W.M. Deckers; J. Lobbestael; G.A. van Wingen; R.P.C. Kessels; A. Arntz; J.I.M. Egger
Background: Borderline personality disorder (BPD) is characterized by severe difficulties in interpersonal relationships and emotional functioning. Theories of BPD suggest that individuals with BPD have heightened emotional sensitivity, increased stress reactivity, and problems in making sense of in
Mohammad Ali Mohammadifar
Full Text Available Objective: The present study was conducted to compare the characteristics of borderline personality, anger, hostility and aggression in addicts with and without suicide ideation. Method: This research was and the causal-comparative research method which is categorized in descriptive one. Sample in this study was included 300 addicts referred to the addiction treatment clinic in Semnan province. By convenience sampling with considering of entry criteria 300 addicts selected and based on the suicidal ideation scores were categorized to two groups with and without suicide ideation. Suicide ideation, buss and Perry’s aggression and borderline personality questionnaires administered among selected sample. Findings: Borderline personality traits, anger, hostility and aggression were higher in suicidal addicts in comparison of non-suicidal. Conclusion: Seems essential screening and identifying addicts which features high aggression and borderline personality for prevention of suicide.
Full Text Available Self-mutilation acts are known to characterize the borderline personality disorders. However, voluntary cutting of the male genital organ remains extremely rare. The present paper reports a case of a 25-years-old young male with a borderline personality. The patient committed a genital self-mutilation (GSM targeting suicide during incarceration stage in jail. In addition, a discussion of the epidemiological and psychopathological aspects of the self-mutilation of borderline patients was been conducted. A particular interest is attributed to the genital self-mutilation and a review of the literature is presented.
Liebke, Lisa; Bungert, Melanie; Thome, Janine; Hauschild, Sophie; Gescher, Dorothee Maria; Schmahl, Christian; Bohus, Martin; Lis, Stefanie
Persistent loneliness is often reported by patients with borderline personality disorder (BPD). However, empirical studies investigating this aspect of BPD psychopathology are sparse. Studies from social psychology revealed that social isolation and low social functioning contribute to loneliness, that is, the subjective feeling of being alone. The aim of the present study was to contribute to the understanding of loneliness in BPD by investigating its relation to social isolation and functioning in different domains of life. Subjective experience of loneliness was measured in 80 women (40 BPD patients, 40 healthy controls) with the UCLA Loneliness Scale. Social isolation and social functioning were assessed with the Social Network Inventory and the Social Functioning Scale. In addition, we assessed global functioning with the Global Assessment of Functioning. BPD patients reported stronger feelings of loneliness compared to healthy participants. In general, the level of loneliness was linked to network size, social engagement, and prosocial behavior. Diversity of social networks and functioning in the domain of interpersonal communication were associated with the level of loneliness only in BPD. A reduced variety of roles in social life together with impairments in interpersonal communication were particularly relevant for the experience of loneliness in BPD, suggesting an indirect path to target this psychopathological feature in therapeutic interventions. However, both social isolation and social functioning were not sufficient to explain the severely increased loneliness experienced by these patients, stressing the need for further investigation of determinants of loneliness in this clinical population. (PsycINFO Database Record
Salzer, Simone; Streeck, Ulrich; Jaeger, Ulrich; Masuhr, Oliver; Warwas, Jasmin; Leichsenring, Falk; Leibing, Eric
Borderline personality disorder (BPD) is characterized by a wide variety of interpersonal problems. We examined whether there are different characteristic interpersonal patterns in BPD and how these patterns are related to symptom distress and therapeutic alliance. In 228 inpatients with diagnoses of BPD, interpersonal subtypes based on the Inventory of Interpersonal Problems (Horowitz et al., Inventar zur Erfassung Interpersonaler Probleme, 2000) were examined through cluster analyses. The global symptom severity and therapeutic alliance were also assessed. We identified five characteristic interpersonal patterns, which we labeled as follows: Cluster 1, "Vindictive"; Cluster 2, "Moderate Submissive"; Cluster 3, "Nonassertive"; Cluster 4, "Exploitable"; and Cluster 5, "Socially Avoidant." The clusters differed significantly in terms of interpersonal distress, interpersonal differentiation, and severity of global symptoms. The ratings of the therapeutic alliance by therapists during treatment significantly differed between the interpersonal subtypes, and the lowest ratings for patients were in the "Socially Avoidant" cluster. Our results stress the impact of interpersonal style on the appearance and treatment of BPD.
Fritzsche, Klaus H.; Brunner, Romuald; Henze, Romy; Meinzer, Hans-Peter; Stieltjes, Bram
As with other mental disorders, the causes of borderline personality disorder (BPD) are complex and not fully understood. In this study we aimed to determine whether adults with BPD exhibit microstructural abnormalities using diffusion tensor imaging (DTI). 56 female right-handed individuals (age range, 14-18 years), 19 with a DSM-IV diagnosis of BPD, 18 patients with a DSM-IV defined current psychiatric disorder and 19 healthy control subjects were included. Groups were matched for age and IQ. DTI Images were analyzed using Tract-Based Spatial Statistics (TBSS). The analysis revealed significanty reduced fractional anisotropy (FA) values in the group of BPD patients compared to the normal controls. Similar FA reductions could not be found comparing BPD patients to clinical controls. Several clusters of increased radial (DR), axial (DA), and mean (MD) diffusivity were consistently identified when comparing the BPD patients to clinical as well as to healthy controls. None of the measures showed significant differences between the clinical and healthy controls. Diverse possible factors have been suggested to play a role in the disease, including environmental factors, neurobiological factors, or brain abnormalities. The presented results may play an important role in this ongoing debate.
Hedrick, Alexis N; Berlin, Heather A
Self-perception is disrupted in people with borderline personality disorder (BPD) and depersonalization disorder (DPD), fluctuating with sudden shifts in affect in BPD and experienced as detached in DPD. Measures of implicit self-esteem (ISE), free from conscious control and presentation biases, may highlight how such disruptions of self-concept differentially affect these two populations on an unconscious level. We examined ISE using the Implicit Association Test, along with measures of emotion, behavior, and temperament, in BPD (n = 18), DPD (n = 18), and healthy control (n = 35) participants. DPD participants had significantly higher ISE and were more harm avoidant than BPD and control participants, while BPD participants had more "frontal" behaviors and impulsivity and less self-directedness and cooperativeness than DPD and control participants. Thus, while BPD and DPD commonly overlap in terms of dissociative symptoms and emotional irregularities, differences in self-esteem, behavior, and temperament can help identify where they diverge in terms of their cognition, behavior, and ultimately underlying neurobiology.
Simeon, Daphne; Hamilton, Holly; Kim, Suah; Crystal, Sarah; Braun, Ashley; Vicens, Victor; Hollander, Eric
We investigated the effects of intranasal oxytocin (OXT) on trust and cooperation in borderline personality disorder (BPD), a disorder marked by interpersonal instability and difficulties with cooperation. Although studies in healthy adults show that intranasal OXT increases trust, individuals with BPD may show an altered response to exogenous OXT because the effects of OXT on trust and pro-social behavior may vary depending on the relationship representations and expectations people possess and/or altered OXT system functioning in BPD. BPD and control participants received intranasal OXT and played a social dilemma game with a partner. Results showed that OXT produced divergent effects in BPD participants, decreasing trust and the likelihood of cooperative responses. Additional analyses focusing on individual differences in attachment anxiety and avoidance across BPD and control participants indicate that these divergent effects were driven by the anxiously attached, rejection-sensitive participants. These data suggest that OXT does not uniformly facilitate trust and pro-social behavior in humans; indeed, OXT may impede trust and pro-social behavior depending on chronic interpersonal insecurities, and/or possible neurochemical differences in the OXT system. Although popularly dubbed the ‘hormone of love’, these data suggest a more circumspect answer to the question of who will benefit from OXT. PMID:21115541
Full Text Available Self-identity is disrupted in people with borderline personality disorder (BPD and depersonalization disorder (DPD, fluctuating with sudden shifts in affect in BPD and experienced as detached in DPD. Measures of implicit self-esteem, free from conscious control and presentation biases, may highlight how such disruptions of self-concept differentially affect these two populations on an unconscious level. We examined implicit self-esteem using the Implicit Association Test, along with measures of emotion, behavior, and temperament, in BPD (n=18, DPD (n=18, and healthy control (n=35 participants. DPD participants had significantly higher implicit self-esteem and were more harm avoidant than BPD and control participants, while BPD participants had more ‘frontal’ behaviors and impulsivity and less self-directedness and cooperativeness than DPD and control participants. Thus, while BPD and DPD commonly overlap in terms of dissociative symptoms and emotional irregularities, differences in self-esteem, behavior, and temperament can help identify where they diverge in terms of their cognition, behavior, and ultimately underlying neurobiology.
Dolan, Mairead; Völlm, Birgit
Crime rates are low in women compared to men. The two disorders most commonly associated with offending behaviour, antisocial personality disorder (ASPD) and psychopathy, are also less prevalent in female samples. However, developments in forensic psychiatry have often ignored gender, and the utility of constructs such as psychopathy and their assessment instruments in female samples remains unclear. This article presents a review of studies looking at rates of ASPD and psychopathy and on the reliability and validity of assessment instruments of these disorders in women. Gender differences in symptom patterns will be considered. The literature seems to suggest that DSM-IV criteria for ASPD may lead to an underestimation of the prevalence of the disorder in women due to the requirement of childhood conduct disorder symptoms. The Psychopathy Checklist-Revised (PCL-R) is a valid and reliable instrument to identify psychopathy in women but there are gender differences in the factor structure and item loadings on this measure. Research to date seems to suggest a three-factor model may be most strongly supported in females. Preliminary evidence suggests the PCL-R may have some value in predicting future offending while the PCL:SV may be useful in predicting institutional violence. Clinical implications are discussed.
Pera-Guardiola, Vanessa; Batalla, Iolanda; Bosque, Javier; Kosson, David; Pifarré, Josep; Hernández-Ribas, Rosa; Goldberg, Ximena; Contreras-Rodríguez, Oren; Menchón, José M; Soriano-Mas, Carles; Cardoner, Narcís
Neuropsychological deficits in executive functions (EF) have been linked to antisocial behavior and considered to be cardinal to the onset and persistence of severe antisocial and aggressive behavior. However, when psychopathy is present, prior evidence suggests that the dorsolateral prefrontal cortex is unaffected leading to intact EF. Ninety-one male offenders with Antisocial Personality Disorder (ASPD) and 24 controls completed the Wisconsin Card Sorting Test (WCST). ASPD individuals were grouped in three categories according to Psychopathy Checklist-Revised (PCL-R) scores (low, medium and high). We hypothesized that ASPD offenders with high PCL-R scores will not differ from healthy controls in EF and will show better EF performance in comparison with subjects with low PCL-R scores. Results showed that ASPD offenders with low PCL-R scores committed more perseverative errors and responses than controls and offenders with high PCL-R scores, which did not differ from healthy controls. Moreover, scores on Factor 1 and the interpersonal facet of the PCL-R were predictors of better WCST performance. Our results suggest a modulatory role of psychopathy in the cognitive performance of ASPD offenders, and provide further evidence supporting that offenders with ASPD and psychopathy are characterized by a cognitive profile different from those with ASPD without psychopathy.
Ramos, Vera; Canta, Guilherme; de Castro, Filipa; Leal, Isabel
Research suggests that borderline personality disorder (BPD) can be diagnosed in adolescents and is marked by considerable heterogeneity. This study aimed to identify personality features characterizing adolescents with BPD and possible meaningful patterns of heterogeneity that could lead to personality subgroups. The authors analyzed data on 60 adolescents, ages 15 to 18 years, who met DSM criteria for a BPD diagnosis. The authors used latent class analysis (LCA) to identify subgroups based on the personality pattern scales from the Millon Adolescent Clinical Inventory (MACI). LCA indicated that the best-fitting solution was a two-class model, identifying two discrete subgroups of BPD adolescents that were described as internalizing and externalizing. The subgroups were then compared on clinical and sociodemographic variables, measures of personality dimensions, DSM BPD criteria, and perception of attachment styles. Adolescents with a BPD diagnosis constitute a heterogeneous group and vary meaningfully on personality features that can have clinical implications for treatment.
Zakharov, N P
The author suggests a cognitive-analytical concept of personality focusing on cognitively mediated processes of cyclic interaction of different levels of consciousness and subconsciousness represented in the form of emotional-behavioral potential and functional-dynamic system. A cognitive type (cognitype)--a type of personality-centered cognitive operations that determines the pattern of behavioral cycle and distinctive features of social adaptation--is singled out as an integrative basic individual and psychological component of personality. Presented is classification of personality cognitypes, their adaptive and maladaptive variants, correlations between cognitypes and anomalies of personality. The principles of psychotherapy of maladaptive behavior, borderline and addictive disorders (positive reintegration of personality) are substantiated.
Yalch, Matthew M; Hopwood, Christopher J; Fehon, Dwain C; Grilo, Carlos M
Suicide is a leading cause of death among adolescents and suicidal behavior is one of the primary risk factors for youth psychiatric hospitalizations. A number of studies indicate that depression and substance abuse are associated with suicide risk in this population, but less is known about the role of borderline personality features or their incremental influence over other known risk factors in indicating suicidal behavior among adolescents. This study examined whether borderline features were associated with suicide risk when controlling for symptoms of depression and substance abuse in a sample of adolescents hospitalized in an inpatient psychiatric facility. Self-report data from 477 adolescent psychiatric inpatients were used to test hypotheses about the association of borderline features with suicide risk after controlling for other common risk factors. Borderline features were significantly related to suicide risk even after accounting for symptoms of depression and substance abuse. These findings underscore the clinical value of routinely assessing borderline features among adolescents.
Stone, Michael H
Information concerning the longitudinal course of Borderline Personality Disorder (BPD) derives mainly from (a) long-term (10 to 25 year) retrospective follow-up studies, primarily those conducted during the 1980s/1990s, (b) brief (1 to 3 year) follow-up studies of recent randomized controlled trials (RCTs) of several different treatment approaches, and (c) prospective follow-up studies. The patients contacted in the retrospective studies had been treated mostly by psychoanalytically informed approaches or supportive. Though there was a significant suicide rate of 3 to 9%, about two-thirds of the BPD patients eventually achieved a global assessment score in the 60s or beyond. BPD represents a heterogeneous group of patients, whose outcome is a function of many variables, including personality traits (paranoid and narcissistic conducing to less favorable outcomes), cultural differences, socio-economic level, intelligence level, gender, and age of onset. The RCT studies focused on amelioration of the symptom components of BPD, especially tendencies to self-injury and suicide. The currently favored treatment methods showed in a large percentage of patients, a lessening of these self-destructive behaviors after a year or two of treatment. The time spans were too brief to allow assessment of improvement in key life areas (attainment of self-sufficiency in work, widening of the circle of friends, and success in forming satisfactory intimate partnerships). The prospective studies are based on reassessments at regular intervals of BPD patients and a control group with other personality disorders. Over the past 16 years the BPD patients, compared with controls, were slower to achieve remission, and more apt to show cognitive peculiarities initially-though they showed appreciable improvement over time. The "recovered" BPD patients, compared with the non-recovered patients, showed twice the likelihood of achieving a successful intimate relationship. At 16 years the Mc
Laporte, Lise; Paris, Joel; Guttman, Herta; Russell, Jennifer
The aim of this study was to document and compare adverse childhood experiences, and personality profiles in women with borderline personality disorder (BPD) and their sisters, and to determine how these factors impact current psychopathology. Fifty-six patients with BPD and their sisters were compared on measures assessing psychopathology, personality traits, and childhood adversities. Most sisters showed little evidence of psychopathology. Both groups reported dysfunctional parent-child relationships and a high prevalence of childhood trauma. Subjects with BPD reported experiencing more emotional abuse and intrafamilial sexual abuse, but more similarities than differences between probands and sisters were found. In multilevel analyses, personality traits of affective instability and impulsivity predicted DIB-R scores and SCL-90-R scores, above and beyond trauma. There were few relationships between childhood adversities and other measures of psychopathology. Sensitivity to adverse experiences, as reflected in the development of psychopathology, appears to be influenced by personality trait profiles.
Thomsen, Marianne S; Ruocco, Anthony C; Carcone, Dean; Mathiesen, Birgit B; Simonsen, Erik
The present study evaluates the severity of neurocognitive deficits and assesses their relations with self-reported childhood trauma and dimensions of personality psychopathology in 45 outpatients with borderline personality disorder (BPD) matched to 56 non-psychiatric controls. Participants completed a comprehensive battery of neurocognitive tests, a retrospective questionnaire on early life trauma and a dimensional measure of personality psychopathology. Patients with BPD primarily showed deficits in verbal comprehension, sustained visual attention, working memory and processing speed. Comorbid posttraumatic stress disorder (PTSD) and an elevated childhood history of physical trauma were each accompanied by more severe neurocognitive deficits. There were no statistically significant associations between neurocognitive function and dimensions of personality psychopathology. These results suggest that patients with BPD display deficits mainly in higher-order thinking abilities that may be exacerbated by PTSD and substantial early life trauma. Potential relationships between neurocognitive deficits and dimensions of personality psychopathology in BPD need further examination.
Blagov, Pavel S; Westen, Drew
After the introduction of histrionic personality disorder (HPD), nosologists struggled to reduce its overlap with borderline personality disorder and other PDs. We studied the coherence of HPD in adults and adolescents as part of 2 larger studies. Clinicians described a random patient with personality pathology using rigorous psychometrics, including the SWAP-II (a Q-sort that captures personality and its pathology in adults) in study 1 and the SWAP-II-A (the adolescent version) in study 2. Using DSM-IV-based measures, we identified patients who met HPD criteria with varying degrees of diagnostic confidence. Central tendencies in the SWAP-II and SWAP-II-A profiles revealed that both the most descriptive and most distinctive features of the patients included some features of HPD but also many features of borderline personality disorder. Q-factor analyses of the SWAP data yielded 3 types of patients in each of the 2 samples. The HPD diagnosis may not be sufficiently coherent or valid.
Golomb, A; Ludolph, P; Westen, D; Block, M J; Maurer, P; Wiss, F C
Psychoanalytic writers have traced the etiology of borderline personality disorder (BPD) to be a preoedipal disturbance in the mother-child relationship. Despite the prevalence of theories focusing on the role of mothering in the development of BPD, few empirical studies have tested the hypothesis that borderlines were the recipients of unempathic mothering. The current preliminary study compared 13 mothers of borderline adolescents with 13 mothers of normal adolescents. This study found that mothers of borderlines tended to conceive of their children egocentrically, as need-gratifying objects, rather than as individuals with distinct and evolving personalities. This study also found that the mothers of borderlines reported raising their daughters in extremely chaotic families struggling to cope with multiple hardships, including divorce and financial worries. The stressful environmental circumstances reported by the mothers likely affected the borderline daughters directly as well as the mothers' ability to parent effectively and empathically. The results of this study suggest that, as predicted by psychoanalytic theory, a problematic mother-child relationship may play a significant role in the genesis of borderline pathology; however, the life circumstances that contextualize the mother-child relationship also need to be considered when accounting for the etiology of BPD.
Armbrust, Michael; Ehrig, Christian
The emotionally instable personality disorder, mostly called borderline disorder, shows central abnormalities in impulse control as well as instability of mood and identity. It is composed of behaviour problems in creating relationships and in self-management, first of all by high psychophysiological tension. The prevalence of this disorder is 10 % in outpatients and 20 % in inpatients and has therefore high relevance for the medical-psychotherapeutic care system. The treatment is deemed to be complex and interminable. Regarding all evaluated techniques of treatment the best examined is the Dialectical Behavioral Therapy (DBT). This specific therapy, developed in the eighties by Marsha M. Linehan, can be used for inpatient and outpatient treatment and combines single and group sessions. It is essential in mental health care of this disorder, but not available everywhere. Essential part of DBT is the skill training, a specific technique for the acquirement and for exercising skills for mindfulness, modulation of tension, regulation of emotions, structuring of social competence and developing self value. The central goal of DBT is to ensure the survival of the patients, to reduce self- and external aggressive behaviour and to provide inpatient crisis interventions. For sustained crisis management skills for reality acceptance are best fitting. But before, fast available sensory and active body-related skills should be used. Radical acceptance is the most important, since most effective, skill. The skills training, although in use for only twenty years, is permanently expanding in practice and is meanwhile also used for other disorders such as, for example, PTSD or ADHD. Since 2010, there also exists an elaborated DBT-version for adolescents. For medical care politics and health-economic reasons a supply with skills training for in- and outpatients all over the country is desirable.
Goodman, Marianne; Patil, Uday; Triebwasser, Joseph; Hoffman, Perry; Weinstein, Zachary A; New, Antonia
To identify aspects of parental burden associated with borderline personality disorder (BPD), an anonymous internet survey linked to BPD support websites was developed for parents to complete on their BPD offspring and unaffected siblings. The questions cover aspects of the child's life from pregnancy through young adulthood, and query about the impact of the child's BPD on six domains of the parent's life, including physical and emotional health, marriage, job, standard of living, social life, and career trajectory. Additionally, financial burden was assessed with questions pertaining to insurance and out-of pocket costs associated with the BPD disorder. BPD offspring were identified by meeting diagnostic criteria embedded within the survey and having been given a diagnosis of BPD by a professional at some point in their life. We report on 233 female offspring meeting strict criteria for BPD. Parents of daughters with BPD endorsed varying levels of impact on the six domains comprising burden with the largest impact on emotional health which was impacted in over 88% of the respondents. Over 50% of parents endorsed four or greater of the six burden items. Particular aspects of the offspring's BPD symptom profile correlated with intensity of parental burden included including problems in adolescence with acting out behavior (p disorder led to about $50,000 in additional costs. Parents of female offspring with BPD experience burden in multiple domains of their life and many have incurred substantial financial expense. Increasing awareness of co-morbid conditions in the BPD proband that significantly increase parental burden may be indicators for the provision of increased family support.
Mauricio, Anne Marie; Tein, Jenn-Yun; Lopez, Frederick G
Court-mandated male batterers (n = 192) attending an intervention program completed measures examining adult attachment orientations (anxious and avoidant), personality disorders (borderline and antisocial), type of violence (psychological and physical), and social desirability. Structural equation modeling was used to determine whether there were significant relationships between anxious attachment and physical and psychological violence that are mediated by either borderline or antisocial personality disorders. Social desirability was included in both models as a covariate. Results indicated that personality disorders fully mediated the relationship between avoidant attachment and physical as well as psychological violence. Personality disorders only partially mediated the relationship between anxious attachment and psychological violence. Implications for intervention are discussed.
Lind, Majse; Thomsen, Dorthe Kirkegaard; Bøye, Rikke
. Thirty patients with BPD and thirty matched control participants described and answered questions about their personal life stories and their parents’ life stories and completed measures of identity disturbance, alexithymia, empathy, and emotional intelligence. Compared to the control group, patients......Patients suffering from borderline personality disorder (BPD) display disturbances in understanding both their own and other people’s mind. We examined whether impaired self- and other understanding would also be evident when patients with BPD described their own and their parents’ life stories...... with BPD described both their personal and their parents’ life stories more negatively and with fewer themes of agency and communion fulfillment. Patients and controls reasoned about their personal life stories in equally complex ways, but patients displayed less complexity, when reasoning about...
Marijn A Distel
Full Text Available Borderline personality disorder is a severe personality disorder for which genetic research has been limited to family studies and classical twin studies. These studies indicate that genetic effects explain 35 to 45% of the variance in borderline personality disorder and borderline personality features. However, effects of non-additive (dominance genetic factors, non-random mating and cultural transmission have generally not been explored. In the present study an extended twin-family design was applied to self-report data of twins (N = 5,017 and their siblings (N = 1,266, parents (N = 3,064 and spouses (N = 939 from 4,015 families, to estimate the effects of additive and non-additive genetic and environmental factors, cultural transmission and non-random mating on individual differences in borderline personality features. Results showed that resemblance among biological relatives could completely be attributed to genetic effects. Variation in borderline personality features was explained by additive genetic (21%; 95% CI 17-26% and dominant genetic (24%; 95% CI 17-31% factors. Environmental influences (55%; 95% CI 51-60% explained the remaining variance. Significant resemblance between spouses was observed, which was best explained by phenotypic assortative mating, but it had only a small effect on the genetic variance (1% of the total variance. There was no effect of cultural transmission from parents to offspring.
Nelson, David A; Coyne, Sarah M; Swanson, Savannah M; Hart, Craig H; Olsen, Joseph A
Crick, Murray-Close, and Woods (2005) encouraged the study of relational aggression as a developmental precursor to borderline personality features in children and adolescents. A longitudinal study is needed to more fully explore this association, to contrast potential associations with physical aggression, and to assess generalizability across various cultural contexts. In addition, parenting is of particular interest in the prediction of aggression or borderline personality disorder. Early aggression and parenting experiences may differ in their long-term prediction of aggression or borderline features, which may have important implications for early intervention. The currrent study incorporated a longitudinal sample of preschool children (84 boys, 84 girls) living in intact, two-parent biological households in Voronezh, Russia. Teachers provided ratings of children's relational and physical aggression in preschool. Mothers and fathers also self-reported their engagement in authoritative, authoritarian, permissive, and psychological controlling forms of parenting with their preschooler. A decade later, 70.8% of the original child participants consented to a follow-up study in which they completed self-reports of relational and physical aggression and borderline personality features. The multivariate results of this study showed that preschool relational aggression in girls predicted adolescent relational aggression. Preschool aversive parenting (i.e., authoritarian, permissive, and psychologically controlling forms) significantly predicted aggression and borderline features in adolescent females. For adolescent males, preschool authoritative parenting served as a protective factor against aggression and borderline features, whereas authoritarian parenting was a risk factor for later aggression.
The question of the existence of rational drug treatment of borderline personality disorder is discussed from two different positions. To the empiricists, the answer must rely on rigorous analysis of controlled drug trials, while to the realists theoretical conceptions of borderline personality disorder must also be seriously addressed. A rational pharmacotherapy can be claimed even when the nosological status of the disorder is not clarified but must be based on a dimensional analysis of psychopathology. Current psychotropic drugs have some but not any too impressive efficacy in the treatment of borderline personality disorder. It is argued that future drug treatment may benefit from the progress in neuroscience, especially within the area of psychobiology of personality.
The scope of case management has expanded to include persons with chronic, nonpsychotic disorders, in particular, persons diagnosed with borderline personality disorder. Despite more widespread use, literature about case management for persons with this disorder is limited. To address this gap in knowledge, a study of the day-to-day experiences of case managers who care for persons with borderline personality disorder was conducted. Seventeen community mental health center case managers gave their informed consent to participate in individual, in-depth interviews. The interviews were analyzed using an interpretive phenomenological research approach. The analysis showed a pattern of monitoring self-involvement. The case managers monitored themselves in terms of expressing concern and setting boundaries. These shared practices highlight a central and unique component of being a case manager for persons with borderline personality disorder, that is, the case manager's focus of attention is on self. By focusing on the self, case managers seek to retain control of the nature of the relationship. The author asserts that the matter to be resolved is not to determine whether retaining or relinquishing control is better, but rather, how best to help practitioners maintain a helpful relationship over time with persons who have borderline personality disorder. In an effort to accomplish this goal, questions about current helping practices and suggestions for working collaboratively with persons who have this diagnosis are provided.
Full Text Available Affective instability and self-injurious behavior are important features of Borderline Personality Disorder. Whereas affective instability may be caused by a pattern of limbic hyperreactivity paired with dysfunctional prefrontal regulation mechanisms, painful stimulation was found to reduce affective arousal at the neural level, possibly underlying the soothing effect of pain in BPD.We used psychophysiological interactions to analyze functional connectivity of (para- limbic brain structures (i.e. amygdala, insula, anterior cingulate cortex in Borderline Personality Disorder in response to painful stimulation. Therefore, we re-analyzed a dataset from 20 patients with Borderline Personality Disorder and 23 healthy controls who took part in an fMRI-task inducing negative (versus neutral affect and subsequently applying heat pain (versus warmth perception.Results suggest an enhanced negative coupling between limbic as well as paralimbic regions and prefrontal regions, specifically with the medial and dorsolateral prefrontal cortex, when patients experienced pain in addition to emotional arousing pictures. When neutral pictures were combined with painful heat sensation, we found positive connectivity in Borderline Personality Disorder between (para-limbic brain areas and parts of the basal ganglia (lentiform nucleus, putamen, as well areas involved in self-referential processing (precuneus and posterior cingulate.We found further evidence for alterations in the emotion regulation process in Borderline Personality Disorder, in the way that pain improves the inhibition of limbic activity by prefrontal areas. This study provides new insights in pain processing in BPD, including enhanced coupling of limbic structures and basal ganglia.
Fossati, Andrea; Gratz, Kim L; Maffei, Cesare; Borroni, Serena
The present study aimed to test if measures of emotion dysregulation and impulsivity additively predicted dimensional scores of borderline personality disorder assessed using the Borderline Personality Disorder Scale of the Personality Diagnostic Questionnaire-4+ in two independent samples of Italian nonclinical adolescents. Hierarchical regression analyses showed that three dimensions of emotion dysregulation (difficulties controlling impulsive behaviours when distressed, limited access to effective emotional regulation strategies and lack of emotional clarity) were significantly associated with BPD features in both samples. Further, impulsivity scores accounted for a significant amount of additional variance in BPD features above and beyond emotion dysregulation.
Hilda C P Morana
Full Text Available OBJETIVO: Apresentar as características básicas dos diversos transtornos específicos de personalidade, mas centrando-se no transtorno de personalidade anti-social, fazendo sua diferenciação com psicopatia. O estudo ainda se propõe a abordar a figura do serial killer, apontando a presença de aspectos psicopáticos no homicídio seriado. MÉTODO: Uma revisão bibliográfica foi feita no sentido de se abordar convergências e divergências entre diversos autores sobre um assunto tão polêmico, sobretudo quanto à viabilidade de tratamento dessa clientela forense. RESULTADOS: Enquanto o transtorno de personalidade anti-social é um diagnóstico médico, pode-se entender o termo "psicopatia", pertencente à esfera psiquiátrico-forense, como um "diagnóstico legal". Não se pode falar ainda de tratamento eficaz para os chamados "serial killers". CONCLUSÃO: Os transtornos de personalidade, especialmente o tipo anti-social, representam ainda hoje um verdadeiro desafio para a psiquiatria forense. O local mais adequado e justo para seus portadores, bem como recomendação homogênea e padronizada de tratamento são questões ainda não respondidas.OBJECTIVE: To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed. METHOD: A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment. RESULTS: While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers. CONCLUSION: Personality disorders
Anton, Marja E; Baskin-Sommers, Arielle R; Vitale, Jennifer E; Curtin, John J; Newman, Joseph P
Psychopathy and antisocial personality disorder (APD) have long been considered important risk factors for criminal behavior and incarceration. However, little is known about the psychobiological underpinnings that give rise to the disinhibited behavior of female offenders. Using an instructed fear-conditioning paradigm and a sample of incarcerated female offenders, we manipulated attentional focus and cognitive load to characterize and differentiate between the dysfunctional cognitive and affective processes associated with these syndromes. We used fear-potentiated startle (FPS) and event-related potentials as measures of affective and cognitive processing, respectively. After controlling for APD symptoms, psychopathic women displayed greater FPS while attending directly to threat-relevant stimuli and displayed less FPS while performing a demanding task that directed attention to threat-irrelevant information. Conversely, controlling for psychopathy, women with high APD symptoms displayed less overall FPS, especially when instructed to focus on threat-relevant stimuli. However, as the demands on cognitive resources increased, they displayed greater FPS. For both psychopathy and APD, analysis of the event-related potentials qualified these findings and further specified the abnormal cognitive processes associated with these two syndromes. Overall, simultaneous analysis of psychopathy and APD revealed distinct patterns of cognitive processing and fear reactivity.
Stephane A De Brito
Full Text Available BACKGROUND: Impairments in executive function characterize offenders with antisocial personality disorder (ASPD and offenders with psychopathy. However, the extent to which those impairments are associated with ASPD, psychopathy, or both is unknown. METHODS: The present study examined 17 violent offenders with ASPD and psychopathy (ASPD+P, 28 violent offenders with ASPD without psychopathy (ASPD-P, and 21 healthy non-offenders on tasks assessing cool (verbal working memory and alteration of motor responses to spatial locations and hot (reversal learning, decision-making under risk, and stimulus-reinforcement-based decision-making executive function. RESULTS: In comparison to healthy non-offenders, violent offenders with ASPD+P and those with ASPD-P showed similar impairments in verbal working memory and adaptive decision-making. They failed to learn from punishment cues, to change their behaviour in the face of changing contingencies, and made poorer quality decisions despite longer periods of deliberation. Intriguingly, the two groups of offenders did not differ significantly from the non-offenders in terms of their alteration of motor responses to spatial locations and their levels of risk-taking, indicated by betting, and impulsivity, measured as delay aversion. The performance of the two groups of offenders on the measures of cool and hot executive function did not differ, indicating shared deficits. CONCLUSIONS: These documented impairments may help to explain the persistence of antisocial behaviours despite the known risks of the negative consequences of such behaviours.
Barnow, Sven; Spitzer, Carsten; Grabe, Hans J.; Kessler, Christoph; Freyberger, Harald J.
Objective: The aim of this study was to examine individual characteristics, familial experience, and psychopathology of children of mothers with borderline personality disorder (BPD). Method: Children of mothers with BPD were compared to children of mothers (1) with depressive disorders, (2) with cluster C personality disorders, and (3) without…
Stepp, Stephanie D.
Recognizable symptoms and features of borderline personality disorder (BPD) appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood. This has resulted in little…
Are DSM-IV-TR borderline personality disorder, ICD-10 emotionally unstable personality disorder, and CCMD-III impulsive personality disorder analogous diagnostic categories across psychiatric nomenclatures?
Lai, Ching Man; Leung, Freedom; You, Jianing; Cheung, Fanny
This study examined the validity of the borderline construct which encompasses diagnostic criteria from the DSM-IV-TR Borderline Personality Disorder (BPD), ICD-10 Emotionally Unstable Personality Disorder (EUPD), and CCMD-III Impulsive Personality Disorder (IPD) in a sample of 1,419 Chinese psychiatric patients. Participants completed the Chinese Personality Disorder Inventory and the Chinese Personality Assessment Inventory-2 assessing various disordered personality features. Adequate internal consistency was found for the borderline construct (α = .83). Exploratory factor analysis revealed two components: (1) affective and cognitive disturbances, and (2) impulse dysregulation, which were replicated by confirmatory factor analysis. Item analysis indicated that the various borderline criteria displayed similar levels of diagnostic efficiency, which does not support the elimination of fear of abandonment and transient psychotic features from the EUPD and IPD criteria set. Findings of this study suggest that BPD, EUPD, and IPD may represent analogous diagnostic categories across classification systems.
Ogłodek, Ewa; Araszkiewicz, Aleksander
Currently, there are two main directions of explaining the occurrence of the borderline personality disorders (BPD). The first of them attempts to explain them upon the constitutional basis, finding the causes in the genetic conditioning, biological and organic factors. The other one underline a role of the psychological developmental categories. A significant role is ascribed to traumatic childhood mental experiences such as: harassment and sexual abuse, as well as neglect of emotional and developmental needs of a child. About 40-71% of the infirm with the borderline personality admits to have been sexually abused. It was observed that there is a connection between the extent of sexual abuse of an individual in childhood and the intensification of the disorders proper for the borderline personality. One should, however, point out that sexual abuse, although they are regarded as a risk factor, are not seen as specific to the infirm with the borderline personality disorders. Moreover, there is a third direction referred to in the literature, seeking the causes of the occurrence of the borderline personality in a significant influence of social-cultural and environment factors. It was noticed that there is a significant correlation between the social situation and the degree of dissemination of those disorders. The borderline personality disorders are more frequent among the people of the low social status background and with relatively low level of education. More and more frequently, theorists and clinical personnel adhere to the view that the development of that disorder is caused by a combination of neurobiological and social factors, together with the pathological qualities of early-childhood development.
Trull, Timothy J; Distel, Marijn A; Carpenter, Ryan W
Recently, the DSM-5 Personality Disorders Workgroup offered its proposed revision for borderline personality disorder (BPD) and other personality disorder types ( http://www.dsm5.org ). According to the workgroup, this revision reflects an attempt to address excessive comorbidity among personality disorders, place personality pathology on continua, and replace individual behavioral criteria with personality traits. Essentially, the committee proposes a hybrid model of BPD (ie, categorical and dimensional)-one that combines the notion of a borderline "type" with supplemental dimensional ratings of relevant personality traits. In this article, we review recent findings on the dimensionality of BPD from phenotypic, genetic, and endophenotypic perspectives. Finally, we evaluate the current DSM-5 proposal for diagnosing BPD-one that ostensibly combines a categorical and dimensional perspective-in light of these findings.
Samuel, Douglas B; Carroll, Kathleen M; Rounsaville, Bruce J; Ball, Samuel A
Although the current diagnostic manual conceptualizes personality disorders (PDs) as categorical entities, an alternative perspective is that PDs represent maladaptive extreme versions of the same traits that describe normal personality. Existing evidence indicates that normal personality traits, such as those assessed by the five-factor model (FFM), share a common structure and obtain reasonably predictable correlations with the PDs. However, very little research has investigated whether PDs are more extreme than normal personality traits. Utilizing item-response theory analyses, the authors of the current study extend previous research to demonstrate that the diagnostic criterion for borderline personality disorder and FFM neuroticism could be fit along a single latent dimension. Furthermore, the authors' findings indicate that the borderline criteria assessed the shared latent trait at a level that was more extreme (d = 1.11) than FFM neuroticism. This finding provides further evidence for dimensional understanding of personality pathology and suggests that a trait model in DSM-5 should span normal and abnormal personality functioning, but focus on the extremes of these common traits.
Wright, Aidan G C; Hopwood, Christopher J; Zanarini, Mary C
There has been significant movement toward conceptualizing borderline personality disorder (BPD) with normal personality traits. However, 1 critical assumption underlying this transition, that longitudinal trajectories of BPD symptoms and normal traits track together, has not been tested. We evaluated the prospective longitudinal associations of changes in Five-Factor Model traits and BPD symptoms over the course of 16 years using parallel process latent growth curve models in 362 patients with BPD (n = 290) or other PDs (n = 72). Moderate to strong cross-sectional and longitudinal associations were observed between BPD symptoms and Neuroticism, Extraversion, Agreeableness, and Conscientiousness. This study is the first to demonstrate a longitudinal link between changes in BPD symptoms and changes in traits over an extended interval in a clinical sample. These findings imply that changes in BPD symptoms occur in concert with changes in normal traits, and support the proposed transition to conceptualizing BPD, at least in part, with trait dimensions.
Full Text Available Much recent research has shown that personality disorders are associated with an altered emotion perception. Whereas most of this research was conducted with stimuli such as faces, the present study examined possible differences in the perception of emotions expressed via body language and body movements. 30 patients with borderline personality disorder and 30 non-patients observed video scenes of emotional human interactions conveyed by point–light displays, rated the depicted valence, and judged their confidence in this rating. Patients with borderline personality disorder showed no altered emotion perception (i.e., no biased perception in either a negative or a positive direction. They did not perceive and evaluate depicted emotions as being more extreme than healthy controls. However, patients with borderline personality disorder showed less confidence in their perception of depicted emotions, especially when these were difficult to identify. The findings extend insights on altered emotion perception in persons with borderline personality disorder to include the field of body movements.
Treloar, Amanda Jane Commons; Lewis, Andrew J.
This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline…
Hawes, David J.; Helyer, Rebekah; Herlianto, Eugene C.; Willing, Jonah
This study tested if children and adolescents with high levels of borderline personality features (BPF) exhibit the same shame-prone self-concept previously found to characterize adults with borderline personality disorder (Rusch et al., 2007). Self-concept was indexed using the Implicit Association Test, in a community sample of…
Sharp, Carla; Kalpakci, Allison; Mellick, William; Venta, Amanda; Temple, Jeff R
At least two leading developmental models of borderline personality disorder (BPD) emphasize the role of accurate reflection and understanding of internal states as significant to the development of BPD features (Fonagy, Int J Psycho-Anal 72:639-656, 1991; Linehan, Cognitive-behavioral treatment of borderline personality disorder, 1993). The current study used the construct of experiential avoidance (EA) to operationalize avoidance of internal states and sought to examine (1) the concurrent relations between EA and borderline features in a large and diverse community sample; and (2) the prospective relation between EA and borderline features over a 1-year follow-up, controlling for baseline levels of borderline features. N = 881 adolescents recruited from public schools in a large metropolitan area participated in baseline assessments and N = 730 completed follow-up assessments. Two main findings were reported. First, EA was associated with borderline features, depressive, and anxiety symptoms at the bivariate level, but when all variables were considered together, depression and anxiety no longer remained significantly associated with borderline features, suggesting that the relations among these symptom clusters may be accounted for by EA as a cross-cutting underlying psychological process. Second, EA predicted levels of borderline symptoms at 1-year follow-up, controlling for baseline levels of borderline symptoms, and symptoms of anxiety and depression. Results are interpreted against the background of developmental theories of borderline personality disorder.
Hepp, Johanna; Carpenter, Ryan W; Lane, Sean P; Trull, Timothy J
Past studies identify Five Factor Model (FFM) domains that are characteristic of borderline personality disorder (BPD), including those associated with specific BPD symptoms, at a between-person level. The present study replicated these between-person associations and extended past research by assessing whether the FFM explains within-person variance in the manifestation of momentary BPD symptoms in the presence or absence of close social contact (CSC). We measured CSC and the BPD core symptoms negative affectivity, impulsivity, and interpersonal problems in 74 BPD patients and in a clinical control group of 40 depressed patients over the course of 28 days, 6 times a day. The FFM domains showed specificity in predicting momentary BPD symptoms and interacted with CSC in doing so. In particular, for BPD individuals only, momentary impulsivity and interpersonal problems were associated with higher neuroticism and extraversion and lower agreeableness, and these associations were especially strong in situations involving CSC. Negative affectivity was predicted by neuroticism for both groups of individuals, and this association was generally unaffected by CSC. Overall, experiencing CSC was positively associated with momentary BPD symptoms. Thus, both the FFM and CSC were associated with BPD patients' experience of symptoms in everyday life. Furthermore, specific FFM trait domains were particularly impactful in contexts where BPD symptoms are more likely to be manifested, providing further evidence that person-by-situation interactions are important for understanding BPD symptoms in the moment. (PsycINFO Database Record
Austin, Marilyn A.; Riniolo, Todd C.; Porges, Stephen W.
The current study provides the first published evidence that the parasympathetic component of the autonomic nervous system differentiates the response profiles between individuals diagnosed with borderline personality disorder (BPD) and controls. Respiratory sinus arrhythmia (RSA), a non-invasive marker of the influence of the myelinated vagal…
Derks, Y.P.M.J.; Westerhof, G.J.; Bohlmeijer, E.T.
Theories on borderline personality pathology (BPP) suggest that characteristic emotional dysregulation is due to low levels of emotional awareness or alexithymia. This study is the first meta-analysis to systematically review and analyze the evidence. A systematic search of the literature was perfor
Helleman, M.; Goossens, P.J.J.; Kaasenbrood, A.; Achterberg, T. van
Brief admission is a crisis intervention for patients with borderline personality disorder (BPD), and refers to a clinical admission at a psychiatric hospital for a period of 1-5 nights. Patients formulate a treatment plan together with their community mental health nurse about the maximum frequency
van Dijke, A.; Ford, J.D.; Van der Hart, O.; Van Son, M.J.M.; Van der Heijden, P.G.M.; Buerhing, M.
Disorders of Extreme Stress Not Otherwise Specified (DESNOS), also known as Complex posttraumatic stress disorder, was assessed in a sample (N = 472) of adult psychiatric patients with confirmed diagnoses of Borderline Personality Disorder (BPD), Somatoform Disorders (SoD), comorbid BPD + SoD, or Af
Panepinto, Amberly R.; Uschold, Carissa C.; Olandese, Michelle; Linn, Braden K.
The study investigated the efficacy of a dialectical behavior therapy (DBT) program with a general college counseling center population, not limited to students diagnosed with borderline personality disorder. A review of records of 64 students found that obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, paranoia,…
Draper, Matthew R.; Faulkner, Ginger E.
This case study examines the dynamics and challenges associated with counseling a client experiencing borderline personality disorder in the small college institutional context. The work of counseling centers at small private institutions has been relatively unexplored in the extant college counseling literature. To help fill this gap, the current…
Bernardon, Stephanie; Pernice-Duca, Francesca
Borderline personality disorder (BPD) presents a number of symptoms and adjustment issues for individuals, but it is also associated with a myriad of risks for the larger family system. A systemic perspective is crucial to comprehending the development of BPD. Promoting healthy relationships with one or more supportive adult enables the child to…
Welch, Stacy Shaw; Linehan, Marsha M.; Sylvers, Patrick; Chittams, Jesse; Rizvi, Shireen L.
Nonsuicidal self-injury (NSSI) and suicide attempts (SAs) are especially prevalent in borderline personality disorder. One proposed mechanism for the maintenance of NSSI and SAs is escape conditioning, whereby immediate reductions in aversive emotional states negatively reinforce the behaviors. Psychophysiological and subjective indicators of…
Stepp, Stephanie D.; Smith, Tiffany D.; Morse, Jennifer Q.; Hallquist, Michael N.; Pilkonis, Paul A.
This study examined the prospective relationships among borderline personality disorder (BPD) symptoms, interpersonal problems, and types of aggressive behaviors (i.e., experiencing psychological and physical victimization and perpetrating psychological and physical aggression) in a psychiatric sample (N = 139) over the course of 2 years. We…
Empirical studies based on psychoanalytic model have concentrated on study of therapeutic process and diagnostic groups such as borderline personality disorder (BPD). Work in BPD provides paradigm for future approaches in study of second-order inferences removed from immediate observational field. Concept of structure may be clarified by empirical…
B. Koekkoek; B. van Meijel; A. Schene; G. Hutschemaekers
The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedu
Lindenboim, Noam; Comtois, Katherine Anne; Linehan, Marsha M.
Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients' practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according…
P. Wetzelaer; J. Farrell; S.M.A.A. Evers; G.A. Jacob; C.W. Lee; O. Brand; G. van Breukelen; E. Fassbinder; H. Fretwell; R.P. Harper; A. Lavender; G. Lockwood; I.A. Malogiannis; U. Schweiger; H. Startup; T. Stevenson; G. Zarbock; A. Arntz
Background: Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has
V. Dickhaut; A. Arntz
Background and Objectives: Schema Therapy (ST) is a highly effective treatment for Borderline Personality Disorder (BPD). In a group format, delivery costs could be reduced and recovery processes catalyzed by specific use of group processes. As patients may also need individual attention, we piloted
Burke, Jeffrey D.; Stepp, Stephanie D.
Very few studies have prospective information, especially regarding males, on the prediction of Borderline Personality Disorder (BPD) in adulthood from psychiatric disorders in childhood. Certain childhood disorders, however, have notably similar features in common with BPD. In particular, the affective dysfunction, hostility and interpersonal…
Ben-Porath, Denise D.
Therapists often struggle with managing intersession contact with clients diagnosed with borderline personality disorder, particularly when dangerous and life-threatening symptoms are communicated (Gunderson, 1996). Difficulties have arisen, in part, because previous phone contacts with this population have failed to recognize the importance of…
Full Text Available Background: Attention Deficit Hyperactivity Disorder (ADHD is a risk factor for Borderline Personality Disorder (BPD during adulthood. Studying the relationship between childhood ADHD disorder symptoms and depression and borderline personality disorder symptoms among students was the main aim of this study. Materials and Methods: A total of 291 students, who were studying in Shiraz and Tabriz universities inThe academic year of 2010-2011, were selected from three groups of Humanities, Basic Sciences, and Technical-Engineering Sciences using simple sampling method. They participated in the study through completing Wender Utah Rating Scale (WURS, Borderline Personality Scale (STB and Beck Depression Inventory (BDI-II. Pearsons correlation coefficient and multiple regression analysis were used to analyze the data. Results: The results showed that there is a significant positive relationship between childhood ADHD and borderline Personality Disorder (BPD in adulthood and childhood ADHD is able to predict BPD in adulthood (p<0.01. Similarly, the relationship between symptoms of childhood ADHD and depression was positive and significant (p<0.01. Conclusion: There is a relationship between symptoms of childhood ADHD, BPD and depression in students. It is recommended to pay due attention to the comorbidity disorders such as BPD and depression in the treatment of ADHD disorder.
Grilo, Carlos M.; Sanislow, Charles A.; Gunderson, John G.; Pagano, Maria E.; Yen, Shirley; Zanarini, Mary C.; Shea, Tracie M.; Skodol, Andrew E.; Stout, Robert L.; Morey, Leslie C.; McGlashan, Thomas H.
The authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive-compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive…
This study identifies childhood personality traits that are precursors of adult Borderline Personality Disorder (BPD) features. In a longitudinal study, childhood personality traits were assessed at age 11 (N = 100) using the California Child Q-set (CCQ: Block and Block, 1980). A number of these Q-items were found to be significantly correlated (p features at age 23. Factor analysis of these Q-items suggested that they could be characterized by two underlying personality dimensions: Impulsivity and Nonconformity/Aggression. The findings thus provide evidence that childhood personality traits predict adult BPD features. Identifying such childhood precursors provides an opportunity for early intervention.
Peters, Jessica R; Upton, Brian T; Baer, Ruth A
Relationships between specific borderline personality disorder (BPD) features and facets of impulsivity (negative and positive urgency, premeditation, perseverance, and sensation seeking) were examined in a sample of 227 undergraduate students, oversampled to include many with elevations on a measure of borderline features. Most facets of impulsivity were positively correlated with borderline features, except for sensation seeking, which showed a mixed pattern of relationships with specific BPD features. In regression models, negative urgency was the strongest predictor of all BPD features scales, including affective instability, identity problems, negative relationships, and self-harm. Premeditation, positive urgency, and sensation seeking demonstrated incremental validity over negative urgency in predicting some BPD features; however, significant beta weights were negative for sensation seeking, suggesting that it may be protective or adaptive for BPD, unlike other forms of impulsivity. This study provides evidence for variation in how types of impulsivity contribute to different BPD features and demonstrates the importance of examining BPD features on the subscale level.
Scott, Lori N; Wright, Aidan G C; Beeney, Joseph E; Lazarus, Sophie A; Pilkonis, Paul A; Stepp, Stephanie D
Theoretical and empirical work suggests that aggression in those with borderline personality disorder (BPD) occurs primarily in the context of emotional reactivity, especially anger and shame, in response to perceived rejection. Using intensive repeated measures, we examined a within-person process model in which perceived rejection predicts increases in aggressive urges and behaviors via increases in negative affect (indirect effect) and in which BPD symptoms exacerbate this process (moderated mediation). Participants were 117 emerging adult women (ages 18-24) with recent histories of aggressive behavior who were recruited from a community-based longitudinal study of at-risk youth. Personality disorder symptoms were assessed by semistructured clinical interview, and aggressive urges, threats, and behaviors were measured in daily life during a 3-week ecological momentary assessment protocol. Multilevel path models revealed that within-person increases in perceived rejection predicted increases in negative affect, especially in women with greater BPD symptoms. In turn, increases in negative affect predicted increased likelihood of aggressive urges or behaviors. Further analysis revealed that BPD symptoms predicted greater anger and shame reactivity to perceived rejection, but not to criticism or insult. Additionally, only anger was associated with increases in aggression after controlling for other negative emotions. Whereas BPD symptoms exacerbated the link between perceived rejection and aggression via increases in negative affect (particularly anger), this process was attenuated in women with greater antisocial personality disorder symptoms. These findings suggest that anger reactivity to perceived rejection is one unique pathway, distinct from antisocial personality disorder, by which BPD symptoms increase risk for aggression. (PsycINFO Database Record
Burgess, J W
Thirty-seven patients with personalities in the dramatic cluster (DSM-III-R histrionic, narcissistic, borderline, and antisocial) and 40 controls matched for age and gender were evaluated on 16 neurocognitive variables. The evaluation screened for deficits in functions of attention, memory, language, abstraction, and behavior planning/sequencing. Analysis of variance revealed significant deficits in neurocognitive performance among patients with dramatic personalities, particularly in subtests requiring multi-step, multi-element associative operations.
Stepp, Stephanie D.
Recognizable symptoms and features of borderline personality disorder (BPD) appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood. This has resulted in little information regarding the development of and risk factors for BPD in youth. The goal of this special section is to examine the development of BPD in adol...
Full Text Available Background: There are models of the development of personality disorders which include individual differences in attachment relationships as causal factors contributed in explanation of these phenomena. The dimensional view of personality disorders represents these conditions as extreme variants of normal personality continua. This study investigated main and interactional effects of attachment styles and personality traits in relation to borderline characteristics. Materials and Methods: The current study was conducted in expo fact context. Randomly selected 603 participants (134 male 469 female from Tabriz Payam-e-Noor, Tarbait Moallem of Azarbaijan and Sarab Payam-e-Noor university students took part in this research. Participants answered to Borderline Personality Inventory (BPI, Eysenck Personality Questionnaire Revised, Short form (EPQ-RS and Adult Attachment Inventory (AAI. Data were analyzed using two way analysis of variance method.Results: Results indicate main effects of attachment styles and personality traits, so, individual with ambivalent insecure attachment experience more intensity of borderline traits than individual with avoidant insecure and secure attachments. Individual with high psychoticim and neuroticism traits experience more intensity of borderline characteristics than individual with extraversion personality traits. Also, there are no interactional effects of attachment styles and personality traits in relation to borderline characteristics. Conclusion: These findings reiterate contribution of childhood risk factors in developing borderline personality disorder, especially in children with emotionally vulnerability.
Hicks, Brian M; Vaidyanathan, Uma; Patrick, Christopher J
Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems, including symptoms of posttraumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to nonviolent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities.
Tragesser, Sarah L; Robinson, R Joe
Current theories of borderline personality disorder (BPD) suggest that extreme levels of affective instability/emotional dysregulation, impulsivity, or a combination of these traits account for the symptoms of BPD. The present study tested the extent to which personality measures of affective instability and impulsivity could account for BPD features in a nonclinical sample. One hundred forty-one undergraduates completed the Affective Lability Scale, the UPPS Impulsive Behavior Scale, and the Personality Assessment Inventory for Borderlines. Both affective instability and impulsivity were uniquely associated with BPD features. Shifts between euthymia and anger, and between anxiety and depression, were associated with BPD features, as were the urgency and (lack of) premeditation scales. Results indicated that specific BPD features may be differentially accounted for by affective instability vs. impulsivity, consistent with perspectives on BPD emphasizing combinations of affective instability and impulsivity as underlying dimensions of the disorder.
Scott, Lori N; Levy, Kenneth N; Pincus, Aaron L
Previous studies have demonstrated that insecure attachment patterns and a trait disposition toward negative affect and impulsivity are both associated with borderline personality disorder (BPD) features. According to attachment theory, insecure attachment patterns impart greater risk for the maladaptive personality traits underlying BPD. Hence, insecure attachment might be indirectly related to BPD through its association with these traits. The current cross-sectional study used structural equation modeling to compare two competing models of the relationship between adult attachment patterns, trait negative affect and impulsivity, and BPD features in a large nonclinical sample of young adults: (M1) attachment anxiety and avoidance are positively related to trait negative affect and impulsivity, which in turn, are directly associated with BPD features; and (M2) trait negative affect and impulsivity are positively related to attachment anxiety and avoidance, which in turn, are directly associated with BPD features. Consistent with attachment theory, M1 provided a better fit to the data than M2. However, only attachment anxiety, and not attachment avoidance, was significantly associated with negative affect and impulsivity. The results favored a model in which the relationship between adult attachment anxiety and BPD features is fully mediated by trait negative affect and impulsivity.
Douglas, Kevin S.; Guy, Laura S.; Edens, John F.; Boer, Douglas P.; Hamilton, Jennine
The Personality Assessment Inventory's (PAI's) ability to predict psychopathic personality features, as assessed by the Psychopathy Checklist-Revised (PCL-R), was examined. To investigate whether the PAI Antisocial Features (ANT) Scale and subscales possessed incremental validity beyond other theoretically relevant PAI scales, optimized regression…
Patrick, Christopher J; Venables, Noah C; Drislane, Laura E
Comments on the original article by Marcus et al. (see record 2011-23134-001). Based on their meta-analytic review of the correlates of the two factors of the Psychopathic Personality Inventory (PPI), Fearless Dominance (FD) and Self-Centered Impulsivity (SCI), Marcus, Fulton, and Edens (this issue, pp. 70-79) raise important questions about the role of FD in diagnostic conceptualizations of psychopathy. In considering their findings, general limitations of metaanalyses (e.g., Ioannidis & Lau, 1999) should be borne in mind, along with specific limitations of their analysis. These limitations are discussed here.
Farid Hoseini F
Full Text Available "nBackground: The Temperament and Character Inventory (TCI efficiently diagnoses personality disorders, differentiating the individual subtypes. This research aimed to evaluate personality dimensions using the Cloninger TCI (TCI-125 in a group of people with borderline personality disorders at Ruzbeh Hospital, Tehran, Iran. "nMethods: In this descriptive cross-sectional study, 27 borderline personality patients were evaluated with a clinical interview based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition text revision (DSM-ІV-TR and Structured Clinical Interview for DSM-ІV Axis IІ (SCIDII. Depression and anxiety scores of patients were assessed using the Beck Depression Inventory (BDI and Beck Anxiety Inventory (BAI questionnaires. Dimensions of temperament and character traits were assessed using the TCI-125. The findings were compared with parameters of the normal Iranian population. "nResults: Results showed higher scores for novelty seeking and harm avoidance and lower scores for self directedness, self transcendence and cooperativeness in borderline personality disorder patients. "nConclusion: The results of the Cloninger TCI in this study showed higher scores for novelty seeking and harm avoidance and lower scores for self directedness than those of the normal Iranian population. Scores for reward dependence fell within the range of the normal population. Lower scores for character factors, such as self directedness, cooperativeness and self transcendence, are usually associated with cluster B personality traits. Higher scores for novelty seeking and harm avoidance are usually characteristic of borderline personality disorder patients. In this study, there is the possibility that the small sample size or other factors, such as medication or substance abuse, might affect the study, resulting in normal scores for reward dependence.
Farrington, David P.
In commenting on the five articles in this special issue, this paper discusses (1) the concept of child and adolescent psychopathy, and whether adolescent psychopaths are qualitatively distinct from other young people; (2) the measurement of adolescent psychopathy; (3) the relationship between psychopathy and other personality dimensions; (4)…
Full Text Available Borderline personality disorder is a complex mental disorder which has severe impact on the quality of an individual's life. Although it is the most common type of personality disorder in the population of people with mental disorders, it has so far proven to be rather resistant to pharmacological treatments. This may suggest that effective psychotherapeutic methods need to be developed to help people with this diagnosis. There have been several attempts to develop successful therapeutic interventions for borderline personality disorder. Most of them were developed either from cognitive-behavioural or from psychoanalytic paradigm. More recent studies have focused on developing a more holistic approach. One such approach is the STEPPS program. This programme combines elements from cognitive-behavioural and systemic approaches. STEPPS is a 20-week, manually based group treatment for patients with borderline personality disorder. In comparison with other established approaches, the STEPPS program does not interfere with patient's other ongoing treatments. In this article we present the basics of the STEPPS program. We also provide a review of studies, investigating the effectiveness of the program. We also discuss advantages and disadvantages of the program and suggest some topics for further research.
Sansone, Randy A; Schumacher, David; Wiederman, Michael W; Routsong-Weichers, Lynn
In this study, we examined the prevalence of binge eating disorder (BED) and borderline personality disorder (BPD) in a sample of 121 candidates seeking surgery for obesity. In this predominantly female sample (85.9%), according to the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R), the prevalence of BED was 6.5%. As for the prevalence of BPD, 14.0% exceeded the clinical cut-off score on the Self-Harm Inventory (SHI), 14.0% exceeded the clinical cut-off score on the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4), and 7.4% exceeded the clinical cut-off score on the McLean Screening Inventory for Borderline Personality Disorder (MSI-BPD). Overall, 24.8% of the sample exceeded the clinical cut-off on at least one measure of BPD whereas only 3.3% exceeded the clinical cut-off on all three measures. In addition, there was a significant inverse relationship between the discrepancy between highest and lowest adult body mass index, and scores on the PDQ-4 and the MSI-BPD. The authors discuss the implications of these findings.
Schuppert, H. Marieke; Albers, Casper J.; Minderaa, Ruud B.; Emmelkamp, Paulus; Nauta, Maaike H.
The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress ha
H.M. Schuppert; C.J. Albers; R.B. Minderaa; P.M.G. Emmelkamp; M.H. Nauta
The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress ha
Borderline personality disorder is a prevalent psychopathology; thus, most graduate students in psychology, residents in psychiatry, and early career clinicians will encounter patients with this disorder in the course of their training or initial professional practice. This paper provides clear and concise guidelines for conducting treatment geared toward the clinician's developmental level. It builds upon the knowledge and skills that are typically acquired during graduate education and training to provide an accessible framework for undertaking psychotherapy with patients who have borderline personality disorder. This paper draws upon common psychotherapeutic factors and existing evidence-based treatments for the disorder to identify principals and interventions that are likely to contribute to therapeutic action. It uses behavioral, cognitive, and psychodynamic interventions to address the patient's multidimensional psychopathology. This approach offers a coherent and integrated treatment framework for the beginning psychotherapy practitioner.
Hurtado, M M; Triviño, M; Arnedo, M; Roldán, G; Tudela, P
This research explored the relationship between executive functions (working memory and reasoning subtests of the Wechsler Adult Intelligence Scale, Trail Making and Stroop tests, fluency and planning tasks, and Wisconsin Card Sorting Test) and emotional intelligence measured by the Mayer-Salovey-Caruso Emotional Intelligence Test in patients with schizophrenia or borderline personality disorder compared to a control group. As expected, both clinical groups performed worse than the control group in executive functions and emotional intelligence, although the impairment was greater in the borderline personality disorder group. Executive functions significantly correlated with social functioning. Results are discussed in relation to the brain circuits that mediate executive functions and emotional intelligence and the findings obtained with other models of social cognition.
Full Text Available PURPOSE: The borderline personality disorder is a common mental disorder. It is frequently associated with various mental co-morbidities and a fundamental loss of functioning. The borderline personality disorder causes high costs to society. The aim of this study was to perform a systematic literature review of existing economic evaluations of treatments for borderline personality disorder. MATERIALS AND METHODS: We performed a systematic literature search in MEDLINE, EMBASE, PsycINFO and NHSEED for partial and full economic evaluations regarding borderline personality disorder. Reported cost data were inflated to the year 2012 and converted into US-$ using purchasing power parities to allow for comparability. Quality assessment of the studies was performed by means of the Consensus on Health Economic Criteria checklist, a checklist developed by a Delphi method in cooperation with 23 international experts. RESULTS: We identified 6 partial and 9 full economic evaluations. The methodical quality was moderate (fulfilled quality criteria: 79.2% [SD: 15.4%] in partial economic evaluations, 77.3% [SD: 8.5%] in full economic evaluations. Most evaluations analysed psychotherapeutic interventions. Although ambiguous, most evidence exists on dialectical-behavioural therapy. Cognitive behavioural therapy and schema-focused therapy are cost-saving. Evidence on other interventions is scarce. CONCLUSION: The economic evidence is not sufficient to draw robust conclusions for all treatments. It is possible that some treatments are cost-effective. Most evidence exists on dialectical-behavioural therapy. Yet, it is ambiguous. Further research concerning the cost-effectiveness of treatments is necessary as well as the identification of relevant cost categories and the validation of effect measures.
Palmer, Stephen; Davidson, Kate; Tyrer, Peter; Gumley, Andrew; Tata, Philip; Norrie, John; Murray, Heather; Seivewright, Helen
Borderline personality disorder places a significant burden on healthcare providers and other agencies. This study evaluated the cost-effectiveness of cognitive behavior therapy plus treatment as usual compared to treatment as usual alone for patients with borderline personality disorder. The economic analysis was conducted alongside a multi-center, randomized controlled trial. The costs of primary and secondary healthcare utilization, alongside the wider economic costs, were estimated from m...
Marcos Hirata Soares
de ese sujeto para relacionarse adecuadamente con otras personas; así, es de fundamental importancia que los miembros del equipo de salud analicen sus sentimientos, actitudes e reacciones en relación al comportamiento del cliente, una vez que la relación con esta clientela es considerada una de las más complejas en salud mental.OBJECTIVE: This study had the objective of reviewing, in the literature, the diagnostic criteria and the intervention in personality disorders, Antisocial and Borderline types. METHODS: A manual research was performed in the author's private collection of books, selecting 12 references; other research has been systematically developed in the period 1990-2008, in January 2009, in the Virtual Health Library, selecting 23 papers. RESULTS: Our findings indicated two approaches - one that classifies as an illness, but that needs to review the diagnostic criteria and evaluation, and the second, that classifies them as moral problems. CONCLUSION: Regardless the type of approach, is necessary that nurses enhance their knowledge and understand the difficulty of this subject to relate properly with others; thus, it is crucial that members of the healthcare team examine their feelings, attitudes and reactions related to the client's behavior, since the relationship with this type of customer is considered one of the most complex in the mental health field.
Flory, Janine D
Comments on the article by F. Mancke et al. (see record 2015-31349-001). The article presents a multidimensional model of aggression in the context of borderline personality disorder (BPD), with a selective review of the research literature. BPD is arguably the most widely researched personality disorder, and the review suggests that there has been extensive progress in characterizing behavioral and biological correlates of aggression. What is not clear from the review, and indeed, the broader literature, is whether the research cited in this review is specific to BPD or can generally be applied to reactive aggression in the context of other disorders (or by extension into the normative range of the behavior). The review by Mancke et al. also highlights the fact that there is a general lack of research establishing predictive validity of aggression in BPD, with most research comparing two groups sampled at one time point.
Full Text Available Although borderline personality disorder and schizophrenia are notably different mental disorders, they share problems in social cognition – or understanding the feelings, intentions and thoughts of other people. To date no studies have directly compared the social cognitive abilities of individuals with these two disorders. In this study, the social cognitive subdomain theory of mind was investigated in females with borderline personality disorder (n = 25, females with schizophrenia (n = 25 and healthy females (n = 25. An ecologically valid video-based measure (Movie for the Assessment of Social Cognition was used. For the overall score, females with schizophrenia performed markedly below both healthy females and females with borderline personality disorder, whereas females with borderline personality disorder did not perform significantly different compared to the healthy control group. A statistically significant error type x group interaction effect indicated that the groups differed with respect to kind of errors. Whereas females with borderline personality disorder made mostly overmentalizing errors, females with schizophrenia in addition committed undermentalizing errors. Our study suggests different magnitude and pattern of social cognitive problems in borderline personality disorder and schizophrenia.
Hopwood, Christopher J.; Zanarini, Mary C.
Objective: Decisions about the composition of personality assessment in the "Diagnostic and Statistical Manual of Mental Disorders" (5th ed.; DSM-V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM)…
Kolla, Nathan J; Meyer, Jeffrey H; Bagby, R Michael; Brijmohan, Amanda
Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are common conditions in forensic settings that present high rates of violence. Personality traits related to the five-factor model personality domains of neuroticism and agreeableness have shown a relationship with physical aggression in nonclinical and general psychiatric samples. The aim of the present investigation was to examine the association of these personality traits with violence and aggression in ASPD and BPD. Results revealed that trait anger/hostility predicted self-reported physical aggression in 47 ASPD and BPD subjects (β = 0.5, p = 0.03) and number of violent convictions in a subsample of the ASPD participants (β = 0.2, p = 0.009). These preliminary results suggest that high anger and hostility are associated with physical aggression in BPD and ASPD. Application of validated, self-report personality measures could provide useful and easily accessible information to supplement clinical risk assessment of violence in these conditions.
Kremers, I P; Van Giezen, A E; Van der Does, A J W; Van Dyck, R; Spinhoven, Ph
The present study investigated the consistency of self-reports of childhood traumatic events in a sample of 50 patients with a borderline personality disorder (BPD) before and after 27 months of intensive treatment with schema focused therapy or transference focused psychotherapy. The mean number of reported sexual, physical and emotional traumatic events did not change following treatment. Test-retest correlations of the trauma-interview also indicated high stability of the total number of sexual, physical and emotional events reported. The majority of the patients, however, did no longer report at least one of the 33 listed events after psychotherapy, and the majority reported at least one event that they had not mentioned before the start of treatment. These findings were not related to type of treatment or changes in suppression, intrusions, avoidance of intrusions, dissociative symptoms, depressive symptoms, and borderline symptoms.
Brand, Bethany L; Lanius, Ruth A
Emotion dysregulation is a core feature of chronic complex dissociative disorders (DD), as it is for borderline personality disorder (BPD). Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1). BPD is a common comorbid disorder with DD, although preliminary research indicates the disorders have some distinguishing features as well as considerable overlap. This article focuses on the epidemiology, clinical presentation, psychological profile, treatment, and neurobiology of chronic complex DD with emphasis placed on the role of emotion dysregulation in each of these areas. Trauma experts conceptualize borderline symptoms as often being trauma based, as are chronic complex DD. We review the preliminary research that compares DD to BPD in the hopes that this will stimulate additional comparative research.
Gregory, Robert J; Remen, Anna L
The authors introduce a manual-based treatment, labeled dynamic deconstructive psychotherapy, developed for those patients with borderline personality disorder who are most difficult to engage in therapy, such as those having co-occurring substance use disorders. This treatment model is based on the hypothesis that borderline pathology and related behaviors reflect impairment in specific neurocognitive functions, including association, attribution, and alterity that form the basis for a coherent and differentiated self. Dynamic deconstructive psychotherapy aims to activate and remediate neurocognitive self-capacities by facilitating elaboration of affect-laden interpersonal experiences and integration of attributions, as well as providing novel experiences in the patient-therapist relationship that promote self-other differentiation. Treatment involves weekly individual sessions for a predetermined period of time and follows sequential stages. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Lynum, L I; Wilberg, T; Karterud, S
This study compared self-esteem in patients with avoidant personality disorder (APD) and borderline personality disorder (BPD). Patients diagnosed with one or more personality disorders answered the questionnaire Index of Self Esteem as part of a comprehensive evaluation within the setting of a treatment trial. Our hypotheses were that (1) both patients with APD and patients with BPD would report low levels of self-esteem, (2) patients with APD would report lower self-esteem than patients with BPD. We further expected that (3) patients with higher levels of depression would report lower levels of self-esteem, but that (4) both borderline and avoidant personality pathology would contribute to explained variance in self-esteem beyond what would be accounted for by depression. All of our hypotheses were supported. The results from our study showed a significant difference in self-esteem level between the two personality disorders, patients with APD reporting lower self-esteem than patients with BPD. Subjects with both disorders were measured to have self-esteem levels within the range that presumes clinical problems. Self-esteem represents an important quality of subjective experience of the self, and the study of self-esteem in PDs can offer new and important knowledge of PDs as self-pathology.
Scott, Lori N; Kim, Yookyung; Nolf, Kimberly A; Hallquist, Michael N; Wright, Aidan G C; Stepp, Stephanie D; Morse, Jennifer Q; Pilkonis, Paul A
Emotional dysregulation and impaired attachment are seen by many clinical researchers as central aspects of borderline personality disorder (BPD). Alternatively, these constructs may represent general impairments in personality that are nonspecific to BPD. Using multitraitmultimethod models, the authors examined the strength of associations among preoccupied attachment, difficulties with emotion regulation, BPD features, and features of two other personality disorders (i.e., antisocial and avoidant) in a combined psychiatric outpatient and community sample of adults. Results suggested that preoccupied attachment and difficulties with emotion regulation shared strong positive associations with each other and with each of the selected personality disorders. However, preoccupied attachment and emotional dysregulation were more strongly related to BPD features than to features of other personality disorders. Findings suggest that although impairments in relational and emotional domains may underlie personality pathology in general, preoccupied attachment and emotional dysregulation also have specificity for understanding core difficulties in those with BPD.
Fossati, Andrea; Krueger, Robert F; Markon, Kristian E; Borroni, Serena; Maffei, Cesare
In order to assess the internal consistency, factor structure, and ability to recover DSM-IV personality disorders (PDs) of the Personality Inventory for DSM-5 (PID-5) scales, 710 Italian adult community dwelling volunteers were administered the Italian translation of the PID-5, as well as the Italian translation of the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Cronbach's alpha values were >.70 for all PID-5 facet scales and greater than .90 for all PID-5 domain scales. Parallel analysis and confirmatory factor analysis supported the theoretical five-factor model of the PID-5 trait scales. Regression analyses showed that both PID-5 trait and domain scales explained a substantial amount of variance in the PDQ-4+ PD scales, with the exception of the Passive-Aggressive PD scale. When the PID-5 was administered to a second independent sample of 389 Italian adult community dwelling volunteers, the basic psychometric properties of the scale were replicated. In this second sample, the PID-5 trait and domain scales proved to be significant predictors of psychopathy measures. As a whole, the results of the present study support the hypothesis that the PID-5 is a reliable instrument which is able to recover DSM-IV PDs, as well as to capture personality pathology that is not included in the DSM-IV (namely, psychopathy).
Pace, Cecilia Serena; Guiducci, Valentina; Cavanna, Donatella
This study aims at examining the attachment states of mind in 50 female outpatients with eating disorders compared with 50 matched control participants using the Adult Attachment Interview. Moreover, the differences in attachment states of mind among eating-disordered women with and without borderline personality disorders' diagnosis were explored. The results showed an over-representation of insecure-dismissing and unresolved states of mind in clinical group compared to controls. Patients with both diagnosis showed higher scores on involving anger and unresolved loss compared with those with only eating disorder. Implications for further research and clinical practice are discussed.
Cousineau, P; Young, J E
The treatment of Borderline Personality Disorder has been a challenge for Cognitive Therapy (CT): some modifications to the CT basic model had to be implemented in order to intervene with BPD patients. Young's schema-focused approach offers an intervention model which relies on early maladaptive schemas and modes concepts. According to this model, the BDP presents four dysfunctional modes: the Abandoned Child mode, the Detached Protector mode, the Punitive Parent mode, the Angry Child mode. The therapist must identify the presence of these modes and implement therapeutic strategies specific to each of them. There are four different kinds of therapeutic strategies: interpersonal (therapy relationship), experiential, cognitive and behavioral.
Sarah Gregory and colleagues1 report a functional MRI study of violent offenders with antisocial personality disorder. 12 men with antisocial personality disorder with psychopathy, 20 men with antisocial personality disorder but not psychopathy, and 18 healthy non-offenders were assessed with an eve
Hopwood, Christopher J; Zanarini, Mary C
Borderline personality disorder (BPD) is related to five-factor model (FFM) traits and can be characterized as involving psychological and behavioral instability. A previous study comparing the FFM trait stability across individuals with borderline and other personality disorders found that the BPD group tended to have lower stability, particularly on neuroticism and conscientiousness and the overall configuration of FFM profiles over 6 years, suggesting that associated psychological and behavioral variability may be due to trait variability. The current study was designed to test the degree to which these findings replicate in another sample using different diagnostic and trait measures and extending the measurement period to 10 years. Results are consistent with previous findings in showing lower differential (rank-order) stability on conscientiousness, greater mean-level decreases on neuroticism, lower individual-level stability on conscientiousness, and lower ipsative stability of trait profile configurations among those with BPD. However, unlike the previous study, no differences were observed for differential or individual-level neuroticism or mean-level conscientiousness. Overall, findings show that the instability characteristic of BPD extends into typically stable personality traits, and that it does so with some specificity in terms of which traits are affected and how instability manifests.
Iacovino, Juliette M; Powers, Abigail D; Oltmanns, Thomas F
Borderline personality disorder (BPD) is associated with obesity, a major risk factor for a number of chronic illnesses (e.g., cardiovascular disease). We examined whether impulsivity and affective instability mediate the association between BPD pathology and body mass index (BMI). Participants were a community sample of adults ages 55-64 and their informants. The Structured Interview for DSM-IV Personality measured BPD symptoms and the Revised NEO Personality Inventory measured self- and informant-report impulsivity and affective instability. Mediation analyses demonstrated that only higher self-report impulsivity significantly mediated the association between greater BPD pathology and higher BMI. A subsequent model revealed that higher scores on the impulsiveness (lack of inhibitory control) and deliberation (planning) facets of impulsivity mediated the BPD-BMI association, with impulsiveness exerting a stronger mediation effect than deliberation. Obesity interventions that improve inhibitory control may be most effective for individuals with BPD pathology.
Simpson, E B; Pistorello, J; Begin, A; Costello, E; Levinson, J; Mulberry, S; Pearlstein, T; Rosen, K; Stevens, M
Dialectical behavior therapy, an outpatient psychosocial treatment for chronically suicidal women with borderline personality disorder, has been adapted for use in a partial hospital program for women. Patients attend the program for a minimum of five days of individual and group therapy, and full census is 12 women. About 65 percent of participants meet at least three criteria for borderline personality disorder, and most have suicidal and self-injurious behavior. Their comorbid diagnoses include trauma-related diagnoses and anxiety disorders, severe eating disorders, substance abuse, and depression. The partial hospital program is linked to an aftercare program offering six months of outpatient skills training based on dialectical behavior therapy. Both programs focus on teaching patients four skills: mindfulness (attention to one's experience), interpersonal effectiveness, emotional regulation, and distress tolerance. Two years of operation of the women's partial hospital program provides promising anecdotal evidence that dialectical behavioral therapy, an outpatient approach, can be effectively modified for partial hospital settings and a more diverse population.
Beeney, Joseph E; Stepp, Stephanie D; Hallquist, Michael N; Scott, Lori N; Wright, Aidan G C; Ellison, William D; Nolf, Kimberly A; Pilkonis, Paul A
Theory and research point to the role of attachment difficulties in borderline personality disorder (BPD). Attachment insecurity is believed to lead to chronic problems in social relationships, attributable, in part, to impairments in social cognition, which comprise maladaptive mental representations of self, others, and self in relation to others. However, few studies have attempted to identify social-cognitive mechanisms that link attachment insecurity to BPD and to assess whether such mechanisms are specific to the disorder. For the present study, empirically derived indices of mentalization, self-other boundaries, and identity diffusion were tested as mediators between attachment style and personality disorder symptoms. In a cross-sectional structural equation model, mentalization and self-other boundaries mediated the relationship between attachment anxiety and BPD. Mentalization partially mediated the relationship between attachment anxiety and antisocial personality disorder (PD) symptoms, and self-other boundaries mediated the relationship between attachment anxiety.
Bradley, Rebekah; Jenei, Johanna; Westen, Drew
A substantial body of research points to several variables relevant to the etiology of borderline personality disorder (BPD), notably childhood physical and sexual abuse, childhood family environment, and familial aggregation of both internalizing and externalizing disorders. However, these variables tend to be correlated, and few studies have examined them simultaneously. A national sample of randomly selected psychologists and psychiatrists described 524 adult patients with personality disorders. Family environment, parental psychopathology, and history of abuse all independently predicted BPD symptoms in multiple regression analyses. Sexual abuse contributed to the prediction of BPD symptoms over and above family environment, although family environmental factors such as instability partially mediated the effect. The results converge with recent studies using very different samples and methodologies.
Livesley, W J
This approach to the treatment of BPD is part of a general framework for treating all forms of personality disorder. The therapeutic model has two components: (1) general strategies to manage core self and interpersonal pathology that characterizes all cases of personality disorder and (2) a specific or tailored component required to treat the problems of individual cases. The general strategies, derived from generic models of therapeutic change and self-psychology, emphasize the therapeutic relationship and the importance of a consistent treatment process, validation, and building motivation. A combination of specific interventions, including medication and psychotherapeutic strategies drawn from treatment approaches, is incorporated into this framework as required. The overall model is not an eclectic approach to treatment but an integrated framework based on an understanding of borderline pathology that emerges from recent research.
Treatment Differences in the Therapeutic Relationship and Introject during a 2-Year Randomized Controlled Trial of Dialectical Behavior Therapy versus Nonbehavioral Psychotherapy Experts for Borderline Personality Disorder
Bedics, Jamie D.; Atkins, David C.; Comtois, Katherine A.; Linehan, Marsha M.
Objective: The present study explored the role of the therapeutic relationship and introject during the course of dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. Method: Women meeting "DSM-IV" criteria for borderline personality disorder (N = 101) were randomized to receive DBT or community…
Miller, Joshua D.; Gaughan, Eric T.; Pryor, Lauren R.
There are several self-report measures of psychopathy, most of which use a two-factor structure. There is debate regarding the convergence of these factors, particularly with regard to Factor 1 (F1), which is related to the interpersonal and affective aspects of psychopathy; Factor 2 (F2) is related to the social deviance associated with…
Verschuere, B.; Uzieblo, K.; De Schryver, M.; Douma, H.; Onraedt, T.; Crombez, G.
The possibility to assess psychopathy through self-report is debated, amongst others, because psychopathic individuals may deliberately underreport psychopathic features (fake good). Meta-analytic research has shown an inverse relation between faking good and self-reported psychopathy, possibly indi
Black, Donald W; Simsek-Duran, Fatma; Blum, Nancee; McCormick, Brett; Allen, Jeff
Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for persons with borderline personality disorder (BPD). We describe results from two data sets on outcome in persons who participated in STEPPS with BPD alone or BPD plus antisocial personality disorder (ASPD). In Study 1, we examined the effect of comorbid ASPD on outcome in 65 persons with BPD who participated in a randomized controlled trial at an academic medical centre. In Study 2, we examined the effect of comorbid ASPD on outcome in 64 offenders with BPD who participated in STEPPS in correctional settings. All subjects were assessed for the presence of BPD and ASPD. In Study 1, subjects with ASPD experienced greater improvement in BPD symptoms, impulsiveness and global symptoms. In Study 2, offenders with ASPD experienced greater improvement in positive and negative behaviours and positive affectivity. We conclude that persons with BPD plus ASPD benefit from STEPPS in community and correctional settings. The findings suggest that persons with BPD plus ASPD show greater improvement in some domains than persons with BPD only. People with ASPD should not be automatically excluded from participation in the program. Copyright © 2015 John Wiley & Sons, Ltd.
Díaz-Marsá, Marina; Carrasco, Jose L; de Anta, Laura; Molina, Rosa; Sáiz, Jerónimo; Cesar, Jesus; López-Ibor, Juan J
Increased and decreased levers of platelet monoamine oxidase (MAO) activity have been reported in patients with eating disorders, indicating abnormalities of the serotonin turnover. However, whether these findings are related to eating disorders or are rather reflecting the pathophysiology of borderline personality traits in these patients is still unknown. Platelet MAO activity and comorbid personality disorders were investigated in 72 patients with different subtypes of eating disorders (ED) and in a group of 28 healthy controls. ED patients comprised the following subtypes: 25 anorexia nervosa (AN) restrictive, 14 AN binge eating-purging (AN b-p), 3 anorexia nervosa not otherwise specified (AN NOS) and 30 bulimia nervosa (BN). Personality disorders and traits were assessed with the Structured Interview for Personality Disorders (SCID-II), the Zanarini Rating Scale for Borderline Personality Disorder, and the Barrat Impulsiveness Scale. Platelet MAO activity was significantly lower in ED patients with comorbid borderline personality disorder (BPD) than in ED without Borderline personality disorder (BDP). Platelet MAO activity was significantly and inversely correlated with the number and severity of BPD clinical features. In the subsample of patients with binge eating-purging symptoms (AN b-p, AN NOS and BN), platelet MAO activity was significantly lower in binge-purge patients with comorbid BPD than in binge-purge patients without BPD. The whole group of eating disorders had a significantly reduced lever of platelet MAO activity compared with the control group. The results suggest that low platelet MAO activity might characterize eating disorders with comorbid borderline personality traits, reflecting greater serotonin dysfunction in these patients. The role of decreased platelet MAO as an endophenotype with specific clinical manifestations should be explored in future studies.
Somma, Antonella; Sharp, Carla; Borroni, Serena; Fossati, Andrea
In order to assess the relationships among borderline personality disorder features, non-suicidal self-injury (NSSI) and emotion dysregulation, 122 community-dwelling Italian adolescents were administered by the Italian translations of the Borderline Personality Features Scale for Children-11, the Deliberate Self-Harm Inventory and the Difficulties in Emotion Regulation Scale (DERS). Regression models showed that both Deliberate Self-Harm Inventory (DSHI) and DERS scores significantly predicted Borderline Personality Features Scale for Children-11 total score; moreover, the DSHI total score significantly predicted the DERS total score. Our findings suggest that borderline personality features in adolescence are moderately, albeit significantly related to NSSI, and that emotion dysregulation does not completely account for the association between borderline personality features and NSSI, although it seems to explain a non-trivial proportion of this relationship. Copyright © 2016 John Wiley & Sons, Ltd.
Soloff, Paul H; Chiappetta, Laurel; Mason, Neale Scott; Becker, Carl; Price, Julie C
Impulsivity and aggressiveness are personality traits associated with a vulnerability to suicidal behavior. Behavioral expression of these traits differs by gender and has been related to central serotonergic function. We assessed the relationships between serotonin-2A receptor function, gender, and personality traits in borderline personality disorder (BPD), a disorder characterized by impulsive-aggression and recurrent suicidal behavior. Participants, who included 33 BPD patients and 27 healthy controls (HC), were assessed for Axis I and II disorders with the Structured Clinical Interview for DSM-IV and the International Personality Disorders Examination, and with the Diagnostic Interview for Borderline Patients-Revised for BPD. Depressed mood, impulsivity, aggression, and temperament were assessed with standardized measures. Positron emission tomography with [(18)F]altanserin as ligand and arterial blood sampling was used to determine the binding potentials (BPND) of serotonin-2A receptors in 11 regions of interest. Data were analyzed using Logan graphical analysis, controlling for age and non-specific binding. Among BPD subjects, aggression, Cluster B co-morbidity, antisocial PD, and childhood abuse were each related to altanserin binding. BPND values predicted impulsivity and aggression in BPD females (but not BPD males), and in HC males (but not HC females.) Altanserin binding was greater in BPD females than males in every contrast, but it did not discriminate suicide attempters from non-attempters. Region-specific differences in serotonin-2A receptor binding related to diagnosis and gender predicted clinical expression of aggression and impulsivity. Vulnerability to suicidal behavior in BPD may be related to serotonin-2A binding through expression of personality risk factors.
Marcos Hirata Soares
OBJETIVO: Este estudo objetivou revisar, na literatura, os critérios diagnósticos e as intervenções nos transtornos de personalidade do tipo Antissocial e Borderline. MÉTODOS: Uma pesquisa manual foi realizada no acervo bibliográfico particular do autor, selecionando-se 12 referências; outra pesquisa sistematizada foi desenvolvida no período de 1990 a 2008, no mês de janeiro de 2009, na Biblioteca Virtual em Saúde, selecionando-se 23 artigos. RESULTADOS: Os achados indicaram duas abordagens -...
Schienle, Anne; Wabnegger, Albert; Schöngassner, Florian; Leutgeb, Verena
The amygdala and the parietal cortex play a key role in the neural representation of personal space. Although the concept of personal space is clinically very relevant for borderline personality disorder (BPD), especially in affective contexts, it has not been investigated thus far with functional magnetic resonance imaging (fMRI). In this fMRI study, 25 female BPD patients and 25 healthy women were exposed to photos of angry, disgusted and neutral facial expressions. All stimuli were once shown as still photos, and once were zoomed-in in order to simulate intrusion into one's own personal space. Approaching faces generally provoked activation of the amygdala and the somatosensory cortex. BPD patients showed an increased activation within both regions, but only toward approaching disgusted faces. Their amygdala activation in this specific condition positively correlated with self-disgust scores. Moreover, the clinical group indicated an enhanced personal distance preference, which was associated with parietal activation. The present study revealed altered personal space processing of BPD patients, especially in situations that relate to social contexts involving disgust. Future studies should focus on the temporal stability of personal space processing during the natural course of BPD as well as during therapy.
Diamond, Diana; Levy, Kenneth N; Clarkin, John F; Fischer-Kern, Melitta; Cain, Nicole M; Doering, Stephan; Hörz, Susanne; Buchheim, Anna
We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Attachment and mentalization were assessed on the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996). Results showed that as expected, compared with the BPD group, the NPD/BPD group was significantly more likely to be categorized as either dismissing or cannot classify on the AAI, whereas the BPD group was more likely to be classified as either preoccupied or unresolved for loss and abuse than was the NPD/BPD group. Both groups of patients scored low on mentalizing, and there were no significant differences between the groups, indicating that both NPD/BPD and BPD individuals showed deficits in this capacity. The clinical implications of the group differences in AAI classification are discussed with a focus on how understanding the attachment representations of NPD/BPD patients helps to illuminate their complex, contradictory mental states.
Zanarini, Mary C; Weingeroff, Jolie L; Frankenburg, Frances R; Fitzmaurice, Garrett M
The purpose of this study was to assess the psychometric properties of the self-report version of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). The measure covers a 1-week time frame, and each of the nine criteria for BPD is rated on a five-point anchored rating scale of 0-4. Seventy-five subjects meeting DSM-IV criteria for BPD were recruited from the community. The convergent validity of the interview and self-report versions of the ZAN-BPD was found to be high (with a median value of 0.70). In terms of reliability, the internal consistency of the nine criteria scores of the ZAN-BPD was found to be good (Cronbach's alpha = 0.84). In addition, 13 of 14 intraclass correlations for same-day test-retest reliability were in the excellent range (> 0.75). Finally, the sensitivity of both versions of the ZAN-BPD to change was assessed 7-10 days after they were first administered and found to be adequate (e.g. r = 0.66 for total score of ZAN-BPD). Taken together, the results of this study suggest that the self-report ZAN-BPD is a promising self-report scale for the assessment of change in the severity of borderline psychopathology over time.
Bromundt, Vivien; Wirz-Justice, Anna; Kyburz, Suzanne; Opwis, Klaus; Dammann, Gerhard; Cajochen, Christian
Individuals with borderline personality disorder (BPD) frequently suffer from sleep disturbances. The authors investigated circadian rhythms, sleep, and well-being in women with BPD in their habitual life conditions during 3 weeks with morning light therapy (LT) and 3 weeks without LT (oLT). Sleep-wake cycles were measured using wrist actimetry, proximal skin temperature as an indirect index of relaxation, as well as weekly salivary melatonin to document the internal circadian rhythm phase. Questionnaires assessed clinical state throughout the 6-week protocol. Ten matched healthy women followed the same 6-week protocol without light treatment. Women with BPD had significantly worse subjective sleep quality and reduced daytime alertness compared to controls. Sleep-wake cycles in BPD ranged from highly disturbed to extremely regular patterns. Melatonin and proximal skin temperature profiles revealed appropriate synchronization of the circadian system with the sleep-wake cycle in most BPD women and in all controls. Morning LT significantly phase-advanced activity in BPD compared to oLT, shortened sleep duration, decreased movement time, and increased skin temperature during sleep (a marker of relaxation). Although general depression scores and borderline symptoms did not change, daytime alertness improved with morning LT, and atypical depression scores were attenuated. Morning LT is a potential adjunct treatment for BPD.
Schindler, Andreas; Sack, Peter-Michael
Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients.
Full Text Available Introduction: Given the disruptive effects of personality disorders on personal and family life, it is essential to recognize their predisposing factors to understand them more accurately, and identify their preventive measures treatment facilitators. Therefore, the present study aimed to examine the relationship of severe personality disorders with behavioral activation and inhibition systems in patients with paranoid, borderline and schizotypal personality disorders. Methods: The present descriptive-correlational study recruited patients with paranoid, borderline and schizotypal personality disorders presenting to psychiatry clinics in Ardabil using convenient sampling method. A total of 30 paranoid patients, 30 borderline patients and 20 schizotypal patients were selected by a psychiatrist through psychiatric examination, clinical interview and completing Millon Clinical Multiaxial Inventory (MCMI-III. The following instruments were used: MCMI- III and behavioral activation-inhibition system scale (BIS-BAS. The data were analyzed with Pearson’s correlation coefficient and stepwise regression. Results: BIS and BAS systems were both significant for predicting borderline and paranoid personality disorders, but only BIS was significant for predicting schizotypal personality disorder. Conclusion: These findings can help experts to have a better and more accurate understanding of personality disorders and use proper methods to predict the probability of these disorders and develop treatments.
The external validity of 10 schizoid personality scales was assessed against dimensional measures of DSM-III borderline (BPD) and schizotypal (SPD) personality disorders in a sample of 37 top-security prisoners. Significant relationships with SPD or BPD emerged for schizophrenism, withdrawn-disturbed relationships, hallucinatory predisposition, schizoidia, disordered thinking and perceptual aberration (r = 0.30-0.66). The first four of these scales were significantly related to SPD (r = 0.29-0.51) after partialling out the effects of BPD, indicating an intrinsic link between these scales and SPD which may constitute the genetic affinity of SPD with schizophrenia. It is suggested that scales which assess the construct of schizophrenism or 'interpersonal aversiveness' may be the most central to Meehl's (1962) 'integrative neural defect' or genetic predisposition to schizotypy.
Morton, Jane; Snowdon, Sharon; Gopold, Michelle; Guymer, Elise
A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current…
Wapp, Manuela; van de Glind, Geurt; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Verspreet, Sofie; Carpentier, Pieter Jan; Ramos-Quiroga, Josep Antoni; Skutle, Arvid; Bu, Eli-Torlid; Franck, Johan; Konstenius, Maija; Kaye, Sharlene; Demetrovics, Zsolt; Barta, Csaba; Fatseas, Melina; Auriacombe, Marc; Johnson, Brian; Faraone, Stephen V.; Levin, Frances R.; Allsop, Steve; Carruthers, Susan; Schoevers, Robert A.; Koeter, Maarten W. J.; van den Brink, Wim; Moggi, Franz
Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interv
Anna Buchheim; Susanne Erk; Carol George; Horst Kächele; Philipp Martius; Dan Pokorny; Manfred Spitzer; Henrik Walter
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging. Eleven female patients with BPD without posttraumatic stress disorder and seventeen healthy female controls matched...
Harned, Melanie S.; Linehan, Marsha M.
Despite the high rate of trauma and PTSD among individuals with borderline personality disorder (BPD), no studies have specifically evaluated the treatment of PTSD in a BPD population. These case studies illustrate the use of a protocol based on prolonged exposure therapy that can be integrated into standard dialectical behavior therapy to treat…
Spinhoven, Philip; Giesen-Bloo, Josephine; van Dyck, Richard; Kooiman, Kees; Arntz, Arnoud
This study investigated the quality and development of the therapeutic alliance as a mediator of change in schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder. Seventy-eight patients were randomly allocated to 3 years of biweekly SFT or TFP. Scores of both therapists and patients for the…
Waltz, Jennifer; Dimeff, Linda A.; Koerner, Kelly; Linehan, Marsha M.; Taylor, Laura; Miller, Christopher
This study tested the feasibility of using a psychoeducational video recording to teach a behavioral skill from the Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b) skills training program to individuals meeting criteria for borderline personality disorder. A video presenting a DBT emotion-regulation skill was developed and the extent to…
Muehlenkamp, Jennifer J.; Ertelt, Troy W.; Miller, Alec L.; Claes, Laurence
Background: There is little research on how specific borderline personality disorder (BPD) symptoms relate to suicide attempts or suicide and non-suicidal self-injury (NSSI) within adolescent populations, which is important to know given the recent proposal of an NSSI disorder. Even less well known is whether specific BPD symptoms distinguish NSSI…
Hopwood, Christopher J.; Morey, Leslie C.; Edelen, Maria Orlando; Shea, M. Tracie; Grilo, Carlos M.; Sanislow, Charles A.; McGlashan, Thomas H.; Daversa, Maria T.; Gunderson, John G.; Zanarini, Mary C.; Markowitz, John C.; Skodol, Andrew E.
Interview methods are widely regarded as the standard for the diagnosis of borderline personality disorder (BPD), whereas self-report methods are considered a time-efficient alternative. However, the relative validity of these methods has not been sufficiently tested. The current study used data from the Collaborative Longitudinal Personality…
Full Text Available This study explored registered psychiatric nurses' (RPNs' interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD. A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the “staff-patient interaction response scale” (SPIRS. Four themes emerged following data analysis: “challenging and difficult,” “manipulative, destructive and threatening behaviour,” “preying on the vulnerable resulting in splitting staff and other service users,” and “boundaries and structure.” Additionally, low levels of empathy were evident in the majority of participants' responses to the SPIRS. The findings provide further insight on nurses' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD.
Reiss, Neele; Vogel, Friederike; Nill, Marco; Graf-Morgenstern, Mechthild; Finkelmeier, Britta; Lieb, Klaus
Patients with severe and chronic psychiatric disorders, such as Borderline Personality Disorder (BPD), are hospitalized frequently, but we often find a high ambivalence regarding treatment in this group of patients. 31 patients with severe BPD participated in an inpatient Schema Therapy (ST) treatment program and evaluated both the intensive ST treatment program and group therapy elements regarding their treatment -satisfaction. A high global treatment satisfaction with the ST treatment program was demonstrated and we found a higher treatment satisfaction in patients with than without BPD specific symptom reductions. Remarkable differences in treatment satisfaction showed when looking at the evaluation of group therapies. The results of the present study demonstrate treatment satisfaction of BPD patients in inpatient ST and give directions for the future development of these programs.
Polgár, Patricia; Fogd, Dóra; Unoka, Zsolt; Sirály, Enikő; Csukly, Gábor
The authors examined social decision-making strategies in borderline personality disorder (BPD) using the Ultimatum Game (UG). They sought to extend previous findings by investigating altruistic punishment, a behavior that increases group cooperation in the long term. They tested the effect of the proposer's facial expression on responses. BPD patients (n = 47) and healthy controls (n = 43) played the responder's role in a series of computerized UG interactions, with proposers expressing positive or negative emotions. BPD patients accepted unfair offers at a higher rate compared to controls. The effect of facial expression differed in the two groups, as positive expressions increased the acceptance likelihood in the control group at stakes from 20:80 to 50:50. In the BPD group, this effect was observed only at higher stakes (40:60 and 50:50). These results suggest that BPD patients exhibit altruistic punishment to a lesser extent and are less influenced by their partners' emotional expression in the UG.
Thomsen, Marianne Skovgaard; Ruocco, Anthony C; Uliaszek, Amanda A
Patients with borderline personality disorder (BPD) have deficits in neurocognitive function that could affect their ability to engage in psychotherapy and may be ameliorated by improvements in symptom severity. In the current study, 18 patients with BPD completed neurocognitive tests prior...... working memory. After 6 months of treatment, patients showed significantly greater increases in sustained attention and perceptual reasoning than controls, with initial deficits in sustained attention among patients resolving after treatment. Improved emotion regulation over the follow-up period...... was associated with increased auditory-verbal working memory capacity, whereas interpersonal functioning improved in parallel with perceptual reasoning. These findings suggest that changes in neurocognitive functioning may track improvements in clinical symptoms in mentalization-based treatment for BPD....
Storebø, Ole Jakob; Simonsen, Erik
Background: Several studies report associations between adults with borderline personality disorder (BPD) and a history of attention-deficit hyperactivity (ADHD) symptoms in childhood. Aims: To explore the association between BPD and a history of ADHD in childhood. Method: A comprehensive search...... seems to give a synergic effect, reinforce the other or complicate the disorders. In one prospective study, the risk factor for children with ADHD to develop BPD was as high as odds ratio 13.16. No studies have looked at treatment of ADHD as a mediator of the risk for BPD. Conclusions: Many studies......: Most of the 15 articles showed a statistical association between ADHD and BPD. The data, most strongly provided a basis for the hypotheses that ADHD is either an early developmental stage of BPD, or that the two disorders share an environmental and genetic aetiology. Furthermore, one of the disorders...
Treatment outlines for Axis I disorders were published during 1982-1985. Treatment outlines for the DSM-III personality disorders are being published. This guide to the treatment of borderline, histrionic and narcissistic disorders was developed from the literature, from the opinions of practising psychiatrists and from the experience of nominated experts. Even though the treatment of patients who suffer from these disorders is very difficult, the surveys of outcome in the literature suggest that a majority of patients improve significantly with long term psychotherapy. In the present outline the expert committee describe a hypothetical model for the genesis of these disorders and outline the steps to be followed if therapy is to be optimal. The experts stress that therapy is often prolonged and difficult but can be rewarding. They caution that therapists are likely to require considerable special training and it is recommended that they seek supervision throughout the process of therapy.
Lobbestael, Jill; McNally, Richard J
The authors tested whether borderline personality disorder (BPD) is characterized by interpretation bias for disambiguating stimuli in favor of threatening interpretations, especially concerning abuse, abandonment, rejection, and anger-core emotional triggers for BPD patients. A mixed sample of 106 patients with marked BPD traits and nonpatients were assessed with SCID I and II and were presented with vignettes depicting ambiguous social interactions. Interpretations of these vignettes were assessed both in a closed and an open answer format. Results showed that BPD traits were related to a rejection- (closed and open answer formats) and an anger-related interpretation bias (closed answer option only). Cluster C traits were associated with self-blame interpretations. Aside from further validating the cognitive model of BPD, these findings denote interpretation bias as a key feature in patients with BPD that might contribute to their emotional hyperreactivity and interpersonal problems. These findings also highlight the importance of therapeutically normalizing interpretative bias in BPD and cluster C patients.
Herr, Nathaniel R; Rosenthal, M Zachary; Geiger, Paul J; Erikson, Karen
Problems with interpersonal functioning and difficulties with emotion regulation are core characteristics of borderline personality disorder (BPD). Little is known, however, about the interrelationship between these areas of dysfunction in accounting for BPD symptom severity. The present study examines a model of the relationship between difficulties with emotion regulation and interpersonal dysfunction in a community sample of adults (n = 124) with the full range of BPD symptoms. Results showed that difficulties with emotion regulation fully mediated the relationship between BPD symptom severity and interpersonal dysfunction. An alternative model indicated that interpersonal problems partially mediated the relationship between difficulties with emotion regulation and BPD symptom severity. These findings support existing theories of BPD, which propose that difficulties with emotion regulation may account for the types of interpersonal problems experienced by individuals with BPD and suggest further examination of the possibility that interpersonal dysfunction may worsen these individuals' difficulties with emotion regulation.
Minzenberg, Michael J; Poole, John H; Vinogradov, Sophia
We characterized borderline personality disorder (BPD) along two fundamental dimensions of adult social attachment and evaluated attachment associations with childhood maltreatment and current symptoms using self-report measures in 40 outpatients with DSM-IV BPD. The BPD group had significantly greater dimensional attachment impairment and rate of fearful attachment type compared with a healthy control group. Among BPD subjects, dimensional attachment-anxiety was specifically associated with sexual abuse, whereas attachment-avoidance was associated with all five maltreatment types. The two attachment dimensions showed divergent associations with current interpersonal problems, impulsivity subtypes and mood symptoms. We conclude that (1) BPD is characterized by adult attachment disturbance; (2) these attachment problems are strongly related to childhood maltreatment, and to current interpersonal problems and clinical symptoms that are considered core features of BPD; and (3) the diverse problems of BPD patients may arise from two basic mechanisms, each tied to a different type of attachment disturbance, developmental history, and clinical outcome.
Feurino, Louis; Silk, Kenneth R
This article reviews the most recent studies of the pharmacologic treatment of borderline personality disorder (BPD). Although research continues using randomized controlled trials with a placebo arm as well as active medication, meta-analyses and systematic reviews have revealed that the use of any specific medication or medication class in BPD remains at best uncertain and inconclusive. Studies indicate that the selective serotonin reuptake inhibitors have fallen out of favor, and researchers have turned their attention to the study of mood stabilizers and atypical antipsychotics. Thus, it is not surprising that trends in prescribing appear to be shifting toward the use of these two classes over the selective serotonin reuptake inhibitors; yet we remain without any medication that has a specific indication for treatment of BPD or an indication for any symptom that is seen as part of the BPD syndrome.
Nordahl, Hans M; Nysaeter, Tor E
The effectiveness of schema therapy for patients with borderline personality disorder (BPD) developed by Young was investigated using a single case series trial of six patients who all had primarily a DSM-IV BPD diagnosis. The treatment approach comprised the core elements of schema therapy with an emphasis on schema mode work and limited re-parenting. An A-B direct replication series with follow-up assessments at 12 months was implemented. From baseline to follow-up improvement was large, as indicated by large effect sizes, and improvement was clinically meaningful for five of the six patients included. Three of the six patients did not any longer fulfill the criteria for BPD by the end of the treatment.
Geiger, Paul J; Peters, Jessica R; Sauer-Zavala, Shannon E; Baer, Ruth A
Previous research has demonstrated that maladaptive cognitive content, including dysfunctional attitudes and negative automatic thoughts, is associated with emotional distress. Similarly, dysfunctional cognitive processes, including thought suppression and rumination, have been shown to intensify psychological difficulties. Although maladaptive cognitive content and dysfunctional processes have been linked to borderline personality disorder (BPD), most research has been conducted with Axis I disorders. This study examined the incremental validity of dysfunctional cognitive content and processes in predicting BPD symptom severity, controlling for trait negative affect, in a sample of undergraduate students (N = 85), including many with high levels of BPD features. Although nearly all variables were significantly correlated with BPD features, final regression models suggest that rumination and thought suppression are stronger independent predictors of BPD features than automatic thoughts, dysfunctional attitudes, and trait negative affect. These results suggest the importance of targeting thought suppression and rumination in BPD.
This study explored registered psychiatric nurses\\' (RPNs\\') interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD). A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the "staff-patient interaction response scale" (SPIRS). Four themes emerged following data analysis: "challenging and difficult," "manipulative, destructive and threatening behaviour," "preying on the vulnerable resulting in splitting staff and other service users," and "boundaries and structure." Additionally, low levels of empathy were evident in the majority of participants\\' responses to the SPIRS. The findings provide further insight on nurses\\' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD.
Full Text Available Uncontrollable emotional lability and impulsivity are a paramount phenomenon of Borderline Personality Disorder (BPD. This paper aims to review theories that entertain emotion dysregulation as the core deficit of BPD and a key factor in the etiology of BPD, in order, then, to propose the author’s own theory, which arguably transcends certain limitations of the earlier ones. The author asserts that his psychodynamic theory explains the symptoms of BPD more thoroughly and it inspires a more parsimonious interpretation of brain imaging findings. In closing, the author draws implications of the proposed theory for clinical practice. He reports an efficacy study for treatment of emotion dysregulation based on that theory.
Kanske, Philipp; Schulze, Lars; Dziobek, Isabel; Scheibner, Hannah; Roepke, Stefan; Singer, Tania
Diagnostic criteria for borderline personality disorder (BPD) include instability in identity and interpersonal relationships. Here, we probed whether instability is already present in BPD patients' thoughts about themselves and others. We tested BPD patients (N=27) and healthy controls (N=25) with a mind-wandering task that assesses content and variability of stimulus-independent self-generated thoughts. Multi-level modeling revealed that while BPD patients and healthy controls mind-wander to a similar extent, BPD patients' thoughts are colored predominantly negatively. Most importantly, although their thoughts concerned the self and others as much as in controls, they fluctuated more strongly in the degree to which their thoughts concerned themselves and others and also gave more extreme ratings. Self- and other related thoughts that were more extreme were also more negative in valence. The increased variability supports current conceptualizations of BPD and may account for the instability in identity and interpersonal relationships.
Widom, Cathy Spatz; Czaja, Sally J; Paris, Joel
Child abuse has been implicated as a risk factor for borderline personality disorder (BPD), yet few prospective longitudinal studies exist. The current study examined whether 500 individuals with documented cases of childhood physical and sexual abuse and neglect were at elevated risk of BPD in adulthood, compared to 396 demographically similar control children. Results indicated that significantly more abused and/or neglected children overall met criteria for BPD as adults, compared to controls, as did physically abused and neglected children. Having a parent with alcohol/drug problems and not being employed full-time, not being a high school graduate, and having a diagnosis of drug abuse, major depressive disorder, and posttraumatic stress disorder were predictors of BPD and mediated the relationship between childhood abuse/neglect and adult BPD. These results call attention to a heightened risk of BPD in physically abused and neglected children and the need to consider multiple pathways to BPD.
Paris, Joel; Black, Donald W
Borderline personality disorder (BPD) and bipolar disorder (types I and II) are frequently confused because of their symptomatic overlap. Although affective instability is a prominent feature of each, the pattern is entirely different. BPD is characterized by transient mood shifts that occur in response to interpersonal stressors, whereas bipolar disorder is associated with sustained mood changes. These disorders can be further distinguished by comparing their phenomenology, etiology, family history, biological studies, outcome, and response to medication. Their distinction is of great clinical importance because misdiagnosis can deprive the patient of potentially effective treatment, whether it is psychotherapy for BPD or medication for bipolar disorder. On the basis of a comprehensive literature review, guidelines for differential diagnosis are suggested, and priorities for further research are recommended.
Frías, Álvaro; González, Laura; Palma, Cárol; Farriols, Núria
Sexual masochism disorder is considered the most prevalent paraphilia among women. However, little is known about the etiology and clinical correlates involved in this disorder. We aimed at addressing this issue through a potentially high-risk clinical cohort. This case-control study consisted of 60 women who met DSM-IV criteria for borderline personality disorder (BPD) and 60 women with other personality disorders. For both groups, sexual masochism disorder comorbidity was assessed through the Structured Clinical Interview, Sexual Disorders Module. Several etiological, psychosexual, and personality features were measured. Sexual masochism disorder was 10 times higher in BPD women than in women with other personality disorders (10 vs. 0 %). Among BPD women, those with sexual masochism disorder reported more child sexual abuse, more hostile/dismissing attachments, higher sensation seeking, and more frequently exploratory/impersonal sexual fantasies than BPD without sexual masochism. Correlation analysis confirmed a significant positive relationship between disinhibition and sexual masochism severity for BPD women. Our findings point out that BPD women may represent a high-risk cohort, especially those with higher disinhibition and detached attachment. Childhood sexual abuse may also play a predispositional role on this comorbidity. Further research may help to elucidate the intriguing relationship between both disorders.
Jovev, Martina; Whittle, Sarah; Yücel, Murat; Simmons, Julian Guy; Allen, Nicholas B; Chanen, Andrew M
Investigating etiological processes early in the life span represents an important step toward a better understanding of the development of personality pathology. The current study evaluated the interaction between an individual difference risk factor (i.e., temperament) and a biological risk factor for aggressive behavior (i.e., atypical [larger] rightward hippocampal asymmetry) in predicting the emergence of borderline personality disorder (BPD) and antisocial personality disorder symptoms during early adolescence. The sample consisted of 153 healthy adolescents (M = 12.6 years, SD = 0.4, range = 11.4-13.7) who were selected from a larger sample to maximize variation in temperament. Interactions between four temperament factors (effortful control, negative affectivity, surgency, and affiliativeness), based on the Early Adolescent Temperament Questionnaire-Revised, and volumetric measures of hippocampal asymmetry were examined as cross-sectional predictors of BPD and antisocial personality disorder symptoms. Boys were more likely to have elevated BPD symptoms if they were high on affiliation and had larger rightward hippocampal asymmetry. In boys, low affiliation was a significant predictor of BPD symptoms in the presence of low rightward hippocampal asymmetry. For girls, low effortful control was associated with elevated BPD symptoms in the presence of atypical rightward hippocampal asymmetry. This study builds on previous work reporting significant associations between atypical hippocampal asymmetry and poor behavioral regulation.
Roth, Gerhard; Strüber, Daniel
Impulsive-reactive violent offenders show increased autonomic activity in response to negative emotional and threatening stimuli. A volume reduction and/or activity decrease of frontal brain structures associated with impulse control and the regulation of fear and anger are likewise found in combination with a fear-related hyperactivity of the amygdala. In addition, impulsive aggression is facilitated by variants of gene polymorphisms influencing the serotonergic system. Conversely, proactive-instrumental violent offender with psychopathy, who are characterized by a lack of empathy and remorse, demonstrate an autonomic hypo-responsivity as well as dysfunctions of the amygdala and of cortical regions related to empathic and social behavior. Developmentally, aggressive children exhibit temperamental differences from early childhood on that are characteristic of a developmental pathway towards either reactive or proactive violence later in life. Exposure to negative environmental factors like ineffective parenting or childhood maltreatment has been related to a heightened risk for developing reactive violence. A developmental trajectory of proactive violence, however, has been related to a mostly genetically determined callous unemotional temperament of the child that disrupts the parental socialization efforts during childhood.
Law, Mary Kate; Fleeson, William; Arnold, Elizabeth Mayfield; Furr, R Michael
While emotional difficulties are highly implicated in borderline personality disorder (BPD), the dynamic relationships between emotions and BPD symptoms that occur in everyday life are unknown. The current paper examined the function of negative emotions as they relate to BPD symptoms in real time. Experience sampling methodology with 281 participants measured negative emotions and borderline symptoms, expressed as a spectrum of experiences, five times daily for two weeks. Overall, having a BDP diagnosis was associated with experiencing more negative emotions. Multilevel modeling supported positive concurrent relationships between negative emotions and BPD symptoms. Lagged models showed that even after 3 hours negative emotions and several symptoms continued to influence each other. Therefore, results indicated that negative emotions and BPD symptoms are intricately related; some evidenced long-lasting relationships. This research supports emotion-symptom contingencies within BPD and provides insight regarding the reactivity and functionality of negative emotions in borderline pathology.
Vater, Aline; Schröder-Abé, Michela; Schütz, Astrid; Lammers, Claas-Hinrich; Roepke, Stefan
The present study examined whether discrepancies between explicit and implicit self-esteem are associated with symptom severity in a sample of patients with borderline personality disorder (BPD). We hypothesized that implicit-explicit self-esteem discrepancies foster autoaggressive behavior and dysphoria, and impair self-perception. We found that the two forms of self-esteem discrepancies, damaged and fragile self-esteem were related to the severity of overall borderline symptoms, autoaggression, dysphoria, and deficits in self-perception. In contrast, more general psychopathological impairment, such as depression, was not related to self-esteem discrepancies. Taken together our results indicate that discrepancies between explicit and implicit self-esteem are associated with certain borderline symptoms that may be based on internal tension. The findings can be interpreted within the framework of self-discrepancies and dichotomous attitudes in patients with BPD.
Full Text Available Background: The goal of this study was to examine the construct validity of the diagnostic and statistical manual of mental disorder-5 (DSM-5 conceptual model of antisocial and borderline personality disorders (PDs. More specifically, the aim was to determine whether the DSM-5 five-factor structure of pathological personality trait domains replicated in an independently collected sample that differs culturally from the derivation sample. Methods: This study was on a sample of 346 individuals with antisocial (n = 122 and borderline PD (n = 130, and nonclinical subjects (n = 94. Participants randomly selected from prisoners, out-patient, and in-patient clients . Participants were recruited from Tehran prisoners, and clinical psychology and psychiatry clinics of Razi and Taleghani Hospital, Tehran, Iran. The SCID-II-PQ, SCID-II, DSM-5 Personality Trait Rating Form (Clinician′s PTRF were used to diagnosis of PD and to assessment of pathological traits. The data were analyzed by exploratory factor analysis. Results: Factor analysis revealed a 5-factor solution for DSM-5 personality traits. Results showed that DSM-5 has adequate construct validity in Iranian sample with antisocial and borderline PDs. Factors similar in number with the other studies, but different in the content. Conclusions: Exploratory factor analysis revealed five homogeneous components of antisocial and borderline PDs. That may represent personality, behavioral, and affective features central to the disorder. Furthermore, the present study helps understand the adequacy of DSM-5 dimensional approach to evaluation of personality pathology, specifically on Iranian sample.
Lobbestael, Jill; Arntz, Arnoud; Sieswerda, Simkje
Complex personality disorders (PDs) have been hypothesized to be characterized by alternating states of thinking, feeling and behavior, the so-called schema modes (Young, Klosko, & Weishaar (2003). Schema therapy: A practioner's guide. New York: Guilford). The present study tested the applicability of this model to borderline personality disorders (BPD) and antisocial personality disorders (APD), and related it to a presumed common etiological factor, childhood trauma. Sixteen patients with BPD, 16 patients with APD and 16 nonpatient controls (all 50% of both sexes) completed a Schema Mode Questionnaire assessing cognitions, feelings and behaviors characteristic of six schema modes. Participants were interviewed to retrace abusive sexual, physical and emotional events before the age of 18. BPD as well as APD participants were characterized by four maladaptive modes (Detached Protector, Punitive Parent, Abandoned/Abused Child and Angry Child). APD displayed most characteristics of the Bully/Attack mode, though not significantly different from BPD. The Healthy Adult mode was of low presence in BPD and of high presence in APD and the nonpatients. Frequency and severity of the three kinds of abuse were equally high in both PD groups, and significantly higher than in nonpatients.
Sadikaj, Gentiana; Moskowitz, D S; Russell, Jennifer J; Zuroff, David C; Paris, Joel
We examined how the amplification of 3 within-person processes (behavioral reactivity to interpersonal perceptions, affect reactivity to interpersonal perceptions, and behavioral reactivity to a person's own affect) accounts for greater quarrelsome behavior among individuals with borderline personality disorder (BPD). Using an event-contingent recording (ECR) methodology, individuals with BPD (N = 38) and community controls (N = 31) reported on their negative affect, quarrelsome behavior, and perceptions of the interaction partner's agreeable-quarrelsome behavior in interpersonal events during a 20-day period. Behavioral reactivity to negative affect was similar in both groups. However, behavioral reactivity and affect reactivity to interpersonal perceptions were elevated in individuals with BPD relative to community controls; specifically, individuals with BPD reported more quarrelsome behavior and more negative affect during interactions in which they perceived others as more cold-quarrelsome. Greater negative affect reactivity to perceptions of other's cold-quarrelsome behavior partly accounted for the increased quarrelsome behavior reported by individuals with BPD during these interactions. This pattern of results suggests a cycle in which the perception of cold-quarrelsome behavior in others triggers elevated negative affect and quarrelsome behavior in individuals with BPD, which subsequently led to more quarrelsome behavior from their interaction partners, which leads to perceptions of others as cold-quarrelsomeness, which begins the cycle anew.
Ferraz, Liliana; Portella, Maria J; Vállez, Mónica; Gutiérrez, Fernando; Martín-Blanco, Ana; Martín-Santos, Rocío; Subirà, Susana
Impulsivity is a multidimensional construct and has been previously associated with suicidal behaviour in borderline personality disorder (BPD). This study examined the associations between suicidal behaviour and impulsivity-related personality traits, as well as history of childhood sexual abuse, in 76 patients diagnosed with BPD using both the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) Axis-II diagnoses and the self-personality questionnaire. Impulsivity-related traits were measured using the Barratt Impulsiveness Scale-11 (BIS-11), the Buss-Durkee Hostility Inventory (BDHI) and the Temperament and Character Inventory-Revised (TCI-R). We found that hostility and childhood sexual abuse, but not impulsivity or other temperament traits, significantly predicted the presence, number and severity of previous suicide attempts. Hostility traits and childhood sexual abuse showed an impact on suicide attempts in BPD. Our results support previous findings indicating that high levels of hostility and having suffered sexual abuse during childhood lead to an increased risk for suicidal behaviour in BPD.
Full Text Available BACKGROUND: Symptom improvement in Borderline Personality Disorder (BPD is more common than previously hypothesised. However, it remains unclear whether it reflects service users' personal goals of recovery. The present study aimed to explore what service users with BPD view as recovery. METHODS: 48 service users were recruited from secondary mental health services and their views on their personal goals and the meaning of recovery were explored in in-depth semi-structured interviews. The study drew on grounded theory and thematic analysis. RESULTS: Service users believed that recovery involved developing self-acceptance and self-confidence, gaining control over emotions, improving relationships, employment, and making progress in symptoms like suicidality and self-harming. They felt that psychotherapies for BPD often had an extreme focus on specific areas, like self-harming or relationships, and that some of their goals were neglected. Although full recovery was seen as a distant goal, interviewees felt that they could learn how to deal with their problems in more effective ways and make meaningful progress in their lives. CONCLUSIONS: Specialist therapies for BPD explicitly address some of the recovery goals that are important to service users, whereas other goals are only indirectly or poorly addressed. Professionals might need to work with service users towards devising comprehensive individualised case formulations, including all treatment targets that are important to service users, their priorities, and long-term plans on how their targets might be met and which services might be involved.
Bos, Elisabeth H.; van Wel, E. Bas; Appelo, Martin T.; Verbraak, Marc J. P. M.
Background: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not m
Bos, E.H.; Wel, B.E. van; Appelo, M.T.; Verbraak, M.J.P.M.
Background: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not m
Crego, Cristina; Widiger, Thomas A
Recently developed models of psychopathy include such traits as fearlessness, boldness, and invulnerability. Section III of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes as well a psychopathy specifier that is modeled after these traits. The purpose of the current study was to test empirically the convergent and discriminant validity of the Psychopathic Personality Inventory-Revised (PPI-R), the Triarchic Psychopathy Measure (TriPM), the Elemental Psychopathy Assessment (EPA), and the Personality Inventory for DSM-5 (PID-5) with respect to their relationship to one another, with traditional measures of psychopathy and antisocial personality disorder, and with a measure of the 5-factor model. Participants were 2 samples of community adults (280 and 196) who indicated that they have engaged in criminal activities. The results indicated good convergent and discriminant validity for the PPI-R, TriPM, EPA, and the PID-5 psychopathy specifiers, as well as relationships with a measure of the 5 factor model that were quite distinct from the relationships obtained for traditional measures of antisocial personality disorder and psychopathy. However, concerns are raised with respect to a reliance on reverse-coded items for the assessment of components of psychopathy.
Full Text Available Objective: This study aimed to compare narcissistic, antisocial, and borderline personality traits among addicted prisoners, non-addict prisoners, and normal subjects. Method: This study employed a causal-comparative research method, with a sample size of 180 participants including addicted prisoners, non-addicted prisoners, and normal individuals (60 participants in each group of Miandoab city who were matched in terms of demographic characteristics. For data collection purposes, narcissistic personality inventory NPI-16, Millon antisocial inventory-III, and borderline personality inventory were employed. Results: The results showed that there was a significant difference between addicted prisoners and normal subjects and also between addicted prisoners and non-addicted prisoners in terms of narcissistic traits while no significant difference was obtained between the non-addicted prisoners and normal subjects. Conclusion: The comparison of the aforementioned groups contains important information for the prevention and treatment of addiction and crime prevention.
Arntz, Arnoud; Klokman, Janet; Sieswerda, Simkje
Young has proposed a schema mode model of borderline personality disorder (BPD), hypothesizing that BPD patients tend to flip from 1 of 4 maladaptive schema modes to another. The present study is the first empirical test of this model, investigating whether these 4 modes are specific for BPD patients and whether BPD-relevant stress specifically increases one of the modes, the detached protector mode. Eighteen BPD patients, 18 cluster-C personality disorder (PD) patients and 18 non-patient controls (all women) filled out trait and state versions of a newly developed schema mode questionnaire, assessing cognitions, feelings and behaviors characteristic of 7 schema modes. Using a cross over design, subjects subsequently watched a neutral and a BPD-specific emotional movie fragment (order balanced). After watching each movie, subjects again filled out the schema mode questionnaire, state version. Trait as well as state versions indicated that BPD patients were indeed characterized by the hypothesized four maladaptive modes (Detached Protector, Punitive Parent, Abused/Abandoned Child, Angry/Impulsive Child). BPD patients were lowest on the Healthy Adult mode. The stress induction induced negative emotions in all groups, but the BPD group was unique in that the Detached Protector mode increased significantly more than in both control groups.
van Asselt Thea
Full Text Available Abstract Background Schema Therapy (ST is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis. Methods/Design Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%. Discussion The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value. Trial Registration The Dutch Cochrane Center, NTR (TC = 1781.
Melca, Isabela A; Yücel, Murat; Mendlowicz, Mauro V; de Oliveira-Souza, Ricardo; Fontenelle, Leonardo F
We assessed correlates of obsessive-compulsive (OCPD), schizotypal (SPD) and borderline (BPD) personality disorders in 110 obsessive-compulsive disorder (OCD) patients. We found OCD patients with OCPD (20.9%) to exhibit higher rates of hoarding and bipolar disorders, increased severity of hoarding and symmetry, lower prevalence of unacceptable thoughts involving sex and religion and less non-planning impulsivity. Conversely, OCD patients with SPD (13.6%) displayed more frequently bipolar disorder, increased severity of depression and OCD neutralization, greater prevalence of "low-order" behaviors (i.e., touching), lower low-planning impulsivity and greater "behavioral" compulsivity. Finally, in exploratory analyses, OCD patients with BPD (21.8%) exhibited lower education, higher rates of several comorbid psychiatric disorders, greater frequency of compulsions involving interpersonal domains (e.g. reassurance seeking), increased severity of depression, anxiety and OCD dimensions other than symmetry and hoarding, more motor and non-planning impulsivity, and greater "cognitive" compulsivity. These findings highlight the importance of assessing personality disorders in OCD samples.
Alicia Domínguez Bermejo
Full Text Available The borderline personality disorder (BPD is defined as a pervasive pattern of instability in interpersonal relationships, self-image and emotions with marked impulsivity. The clinical management of patients diagnosed with BPD is difficult for nurses due to the clinical characteristics of these subjects. This study seeks to address the emotions expressed by nurses working in units of personality disorder.Objectives: To determine the emotions experienced by nurses working in personality disorders treatment units during the care of patients diagnosed with BPD. To describe the type of emotions experienced, positive or negative; to identify the triggering situations for different types of emotions; to explore the influence of the experienced emotions when acting with these patients; to address the different ways to handle emotions based on the received training and professional experience during the care of patients diagnosed with BPD and to address the different ways to handle emotions according to the gender of the nurses. Methodology: Qualitative research in health. The information generation techniques employed are in-depth interviews and focus/debate groups.
The Mediating Role of Emotion Dysregulation in the Relations Between Childhood Trauma History and Adult Attachment and Borderline Personality Disorder Features: A Study of Italian Nonclinical Participants.
Fossati, Andrea; Gratz, Kim L; Somma, Antonella; Maffei, Cesare; Borroni, Serena
In order to evaluate if emotion dysregulation significantly mediates the relationships between childhood abuse and adult attachment and borderline personality disorder features, 354 community Italian adults were administered the Borderline Personality Inventory (Leichsenring, 1999a), the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), the Child Abuse and Trauma Scale (Sanders & Becker-Lausen, 1995), and the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994). Hierarchical regression analyses showed that both childhood abuse and adult attachment were positively associated with emotion dysregulation and borderline personality features; however, only emotional abuse and the attachment dimension of need for approval were common predictors of both dependent variables. No significant interaction effects were detected in regression analyses. Mediation analyses provided support for partial mediation, revealing a significant mediating role of emotion dysregulation in the relationships between both emotional abuse and need for approval and borderline personality features in this community sample.
A. Arntz; S. Stupar-Rutenfrans; J. Bloo; R. van Dyck; P. Spinhoven
Knowing what predicts discontinuation or success of psychotherapies for Borderline Personality Disorder (BPD) is important to improve treatments. Many variables have been reported in the literature, but replication is needed and investigating what therapy process underlies the findings is necessary
Peters, Jessica R; Smart, Laura M; Baer, Ruth A
A growing body of evidence has tied borderline personality disorder (BPD) to heightened sensitivity to rejection; however, mechanisms through which rejection sensitivity contributes to BPD features have not been identified. Rejection may lead to the dysfunctional emotion regulation strategies common in BPD, such as impulsive responses to distress, anger rumination, difficulties engaging in goal-oriented behavior, nonacceptance of emotions, and low emotional clarity. The present study used self-report measures and bootstrapping procedures to investigate the role of difficulties in emotional regulation in the relationship between rejection sensitivity and borderline personality features in a cross-sectional sample of 410 undergraduates. Difficulties in emotion regulation accounted for significant variance in the relationships between rejection sensitivity and BPD features, with varying sets of deficits in emotion regulation skills accounting for associations with specific BPD features. Potential clinical implications and the need for replication in longitudinal studies are discussed.
Full Text Available Abstract Background A combination of multiple factors, including a strong genetic predisposition and environmental factors, are considered to contribute to the developmental pathways to borderline personality disorder (BPD. However, these factors have mostly been investigated retrospectively, and hardly in adolescents. The current study focuses on maternal factors in BPD features in adolescence. Methods Actual parenting was investigated in a group of referred adolescents with BPD features (N = 101 and a healthy control group (N = 44. Self-reports of perceived concurrent parenting were completed by the adolescents. Questionnaires on parental psychopathology (both Axis I and Axis II disorders were completed by their mothers. Results Adolescents reported significantly less emotional warmth, more rejection and more overprotection from their mothers in the BPD-group than in the control group. Mothers in the BPD group reported significantly more parenting stress compared to mothers in the control group. Also, these mothers showed significantly more general psychopathology and clusters C personality traits than mothers in the control group. Contrary to expectations, mothers of adolescents with BPD features reported the same level of cluster B personality traits, compared to mothers in the control group. Hierarchical logistic regression revealed that parental rearing styles (less emotional warmth, and more overprotection and general psychopathology of the mother were the strongest factors differentiating between controls and adolescents with BPD symptoms. Conclusions Adolescents with BPD features experience less emotional warmth and more overprotection from their mothers, while the mothers themselves report more symptoms of anxiety and depression. Addition of family interventions to treatment programs for adolescents might increase the effectiveness of such early interventions, and prevent the adverse outcome that is often seen in adult BPD
Blais, M A; Hilsenroth, M J; Castlebury, F D
This study sought to empirically evaluate the content validity of the newly revised DSM-IV narcissistic personality disorder (NPD) and borderline personality disorder (BPD) criteria sets. Using the essential features of each disorder as construct definitions, factor analysis was used to determine how adequately the criteria sets covered the constructs. In addition, this empirical investigation sought to: 1) help define the dimensions underlying these polythetic disorders; 2) identify core features of each diagnosis; and 3) highlight the characteristics that may be most useful in diagnosing these two disorders. Ninety-one outpatients meeting DSM-IV criteria for a personality disorder (PD) were identified through a retrospective analysis of chart information. Records of these 91 patients were independently rated on all of the BPD and NPD symptom criteria for the DSM-IV. Acceptable interrater reliability (kappa estimates) was obtained for both presence or absence of a PD and symptom criteria for BPD and NPD. The factor analysis, performed separately for each disorder, identified a three-factor solution for both the DSM-IV BPD and NPD criteria sets. The results of this study provide strong support for the content validity of the NPD criteria set and moderate support for the content validly of the BPD criteria set. Three domains were found to comprise the BPD criteria set, with the essential features of interpersonal and identity instability forming one domain, and impulsivity and affective instability each identified as separate domains. Factor analysis of the NPD criteria set found three factors basically corresponding to the essential features of grandiosity, lack of empathy, and need for admiration. Therefore, the NPD criteria set adequately covers the essential or defining features of the disorder.
Buchheim, Anna; Erk, Susanne; George, Carol; Kächele, Horst; Martius, Philipp; Pokorny, Dan; Spitzer, Manfred; Walter, Henrik
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls ...
Sempértegui, Gabriela A; Karreman, Annemiek; Arntz, Arnoud; Bekker, Marrie H J
Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences.
Krause-Utz, Annegret; Keibel-Mauchnik, Jana; Ebner-Priemer, Ulrich; Bohus, Martin; Schmahl, Christian
Previous research suggests disturbed emotional learning and memory in borderline personality disorder (BPD). Studies investigating the neural correlates of aversive differential delay conditioning in BPD are currently lacking. We aimed to investigate acquisition, within-session extinction, between-session extinction recall, and reacquisition. We expected increased activation in the insula, amygdala, and anterior cingulate, and decreased prefrontal activation in BPD patients. During functional magnetic resonance imaging, 27 medication-free female BPD patients and 26 female healthy controls (HC) performed a differential delay aversive conditioning paradigm. An electric shock served as unconditioned stimulus, two neutral pictures as conditioned stimuli (CS+/CS-). Dependent variables were blood-oxygen-level-dependent response, skin conductance response (SCR), and subjective ratings (valence, arousal). No significant between-group differences in brain activation were found [all p(FDR) > 0.05]. Within-group comparisons for CS+unpaired > CS- revealed increased insula activity in BPD patients but not in HC during early acquisition; during late acquisition, both groups recruited fronto-parietal areas [p(FDR) CS during extinction. During extinction recall, there was a trend for stronger SCR to CS+ > CS in BPD patients. Amygdala habituation to CS+paired (CS+ in temporal contingency with the aversive event) during acquisition was found in HC but not in patients. Our findings suggest altered temporal response patterns in terms of increased vigilance already during early acquisition and delayed extinction processes in individuals with BPD.
Kuhlken, Katherine; Robertson, Christopher; Benson, Jessica; Nelson-Gray, Rosemery
Previous research has suggested that stable, marital relationships may have overall prognostic significance for individuals with borderline personality disorder (BPD); however, research focused on the impact of nonmarital, and perhaps short-term, romantic relationships is lacking. Thus, the primary goal of this study was to examine the impact of the interaction of BPD symptoms and relationship satisfaction on state negative affect in college undergraduates. It was predicted that individuals who scored higher on measures of BPD symptoms and who were in a satisfying romantic relationship would report less negative affect than comparable individuals in a less satisfying romantic relationship. Questionnaires assessing BPD symptoms, relationship satisfaction, and negative affect were administered to 111 women, the majority of whom then completed daily measures of relationship satisfaction and negative affect over a 2-week follow-up period. Hierarchical multiple regression and hierarchical linear modeling were used to test the hypotheses. The interaction of BPD symptoms with relationship satisfaction was found to significantly predict anger, as measured at one time point, suggesting that satisfying romantic relationships may be a protective factor for individuals scoring high on measures of BPD symptoms with regard to anger.
Bekrater-Bodmann, Robin; Chung, Boo Young; Richter, Ingmarie; Wicking, Manon; Foell, Jens; Mancke, Falk; Schmahl, Christian; Flor, Herta
It is well documented that borderline personality disorder (BPD) is characterized by reduced pain sensitivity, which might be related to nonsuicidal self-injury and dissociative experiences in patients with BPD. However, it remains an open question whether this insensitivity relies at least partly on altered sensory integration or on an altered evaluation of pain or a combination of both. In this study, we used the thermal grill illusion (TGI), describing a painful sensation induced by the application of alternating cold and warm nonnoxious stimuli, in patients with either current or remitted BPD as well as matched healthy controls. Two additional conditions, applying warm or cold temperatures only, served as control. We further assessed thermal perception, discrimination, and pain thresholds. We found significantly reduced heat and cold pain thresholds for the current BPD group, as well as reduced cold pain thresholds for the remitted BPD group, as compared with the HC group. Current BPD patients perceived a less-intense TGI in terms of induced pain and unpleasantness, while their general ability to perceive this kind of illusion seemed to be unaffected. Thermal grill illusion magnitude was negatively correlated with dissociation and traumatization only in the current BPD patients. These results indicate that higher-order pain perception is altered in current BPD, which seems to normalize after remission. We discuss these findings against the background of neurophysiological evidence for the TGI in general and reduced pain sensitivity in BPD and suggest a relationship to alterations in N-methyl-D-aspartate neurotransmission.
Agnew, Gillian; Shannon, Ciarán; Ryan, Tina; Storey, Lesley; McDonnell, Catherine
Identity disturbance has been suggested to be a core feature of borderline personality disorder (BPD). However, there is little known about the identity of individuals with symptoms of BPD from the participant's perspective. This study availed of in-depth lightly structured life story interviews with five female participants. Thematic analysis was utilized to derive three themes of identity: connection, distance between us, and hurt and healing. Results provided support for multiple and flexible conceptualizations of identity in comparison to the idea of a unitary self/identity. Results also suggested that participants were able to establish differing connections to others ranging from disconnection to intimacy and care. Participants reported that their identities were impacted upon by historical and current family/relationship dysfunction, but life stories also illustrated the positive impact of healing relationship experiences. Findings provide support for psychological theories that consider a multiple and relational self/identity and the empowerment of healthy aspects of the self in BPD recovery. Studies that assess the association between insight and change may further our knowledge into this complex population.
Stepp, Stephanie D; Whalen, Diana J; Scott, Lori N; Zalewski, Maureen; Loeber, Rolf; Hipwell, Alison E
Theories of borderline personality disorder (BPD) postulate that high-risk transactions between caregiver and child are important for the development and maintenance of the disorder. Little empirical evidence exists regarding the reciprocal effects of parenting on the development of BPD symptoms in adolescence. The impact of child and caregiver characteristics on this reciprocal relationship is also unknown. Thus, the current study examines bidirectional effects of parenting, specifically harsh punishment practices and caregiver low warmth, and BPD symptoms in girls aged 14-17 years based on annual, longitudinal data from the Pittsburgh Girls Study (N = 2,451) in the context of child and caregiver characteristics. We examined these associations through the use of autoregressive latent trajectory models to differentiate time-specific variations in BPD symptoms and parenting from the stable processes that steadily influence repeated measures within an individual. The developmental trajectories of BPD symptoms and parenting were moderately associated, suggesting a reciprocal relationship. There was some support for time-specific elevations in BPD symptoms predicting subsequent increases in harsh punishment and caregiver low warmth. There was little support for increases in harsh punishment and caregiver low warmth predicting subsequent elevations in BPD symptoms. Child impulsivity and negative affectivity, and caregiver psychopathology were related to parenting trajectories, while only child characteristics predicted BPD trajectories. The results highlight the stability of the reciprocal associations between parenting and BPD trajectories in adolescent girls and add to our understanding of the longitudinal course of BPD in youth.
Thabata B. de Araujo
Full Text Available Objective: Borderline personality disorder (BPD is a devastating condition that causes intense disruption of patients' lives and relationships. Proper understanding of BPD neurobiology could help provide the basis for earlier and effective interventions. As neuroimaging studies of patients with BPD are still scarce, volumetric and geometric features of the cortical structure were assessed to ascertain whether structural cortical alterations are present in BPD patients. Methods: Twenty-five female outpatients with BPD underwent psychiatric evaluation (SCID-I and II and a 1.5 T magnetic resonance imaging (MRI brain scan. The control group comprised 25 healthy age-matched females. Images were processed with the FreeSurfer package, which allows analysis of cortical morphology with more detailed descriptions of volumetric and geometric features of cortical structure. Results: Compared with controls, BPD patients exhibited significant cortical abnormalities in the fronto-limbic and paralimbic regions of both hemispheres. Conclusion: Significant morphologic abnormalities were observed in patients with BPD on comparison with a healthy control group through a multimodal approach. This study highlights the involvement of regions associated with mood regulation, impulsivity, and social behavior in BPD patients and presents a new approach for further investigation through a method of structural analysis based on distinct and simultaneous volumetric and geometric parameters.
Giulia Zelda De Vidovich
Full Text Available The borderline personality disorder (BPD is characterized by a severe pattern of instability in emotional regulation, interpersonal relationships, identity, and impulse control. These functions are related to the prefrontal cortex (PFC, and since PFC shows a rich anatomical connectivity with the cerebellum, the functionality of the cerebellar-PFC axis may impact on BPD. In this study we investigated the potential involvement of cerebello-thalamo-cortical connections in impulsive reactions through a pre/post stimulation design. BPD patients (n=8 and healthy controls (HC; n=9 performed an Affective Go/No-Go task (AGN assessing information processing biases for positive and negative stimuli before and after repetitive transcranial magnetic stimulation (rTMS; 1 Hz/10 min, 80% RMT over the left lateral cerebellum. The AGN task consisted of four blocks requiring associative capacities of increasing complexity. BPD patients performed significantly worse than the HC, especially when cognitive demands was high (3rd and 4th block, but their performace approached that of HC after rTMS (rTMS was almost ineffective in HC. The more evident effect of rTMS in complex associative tasks might have occurred since the cerebellum is deeply involved in integration and coordination of different stimuli. We hypothesize that, in BPD patients, cerebello-thalamo-cortical communication is altered, resulting in emotional dysregulation and disturbed impulse control. The rTMS over the left cerebellum might have interfered with existing functional connections exerting a facilitating effect on PFC control.
Perepletchikova, Francheska; Ansell, Emily; Axelrod, Seth
This study examines the history of childhood maltreatment and Borderline Personality Disorder (BPD) symptoms in mothers whose children were removed from the home by Child Protective Services (CPS) to identify potential targets for future intervention efforts. Forty-one mothers of children removed from the home due to abuse and/or neglect and 58 community-control mothers without CPS involvement were assessed for history of childhood maltreatment, alcohol and drug use, and BPD features. CPS-involved mothers scored significantly higher on measures of childhood maltreatment history and BPD features than did control mothers. The highest BPD scores were associated with the most severe histories of mothers' childhood maltreatment. In total, 50% of CPS-involved mothers reported elevated BPD features, compared with 15% of control mothers. Further, 19% of CPS-involved mothers had self-reported scores consistent with a BPD diagnosis, compared with 4% of control mothers. BPD features rather than maltreatment history per se predicted maternal involvement with CPS, controlling for alcohol and drug use predictors. The present data suggest that evidence-based treatments to address BPD symptoms may be indicated for some CPS-involved parents.
Nicol, K; Pope, M; Romaniuk, L; Hall, J
Childhood trauma is believed to contribute to the development of borderline personality disorder (BPD), however the mechanism by which childhood trauma increases risk for specific symptoms of the disorder is not well understood. Here, we explore the relationship between childhood trauma, brain activation in response to emotional stimuli and psychotic symptoms in BPD. Twenty individuals with a diagnosis of BPD and 16 healthy controls were recruited to undergo a functional MRI scan, during which they viewed images of faces expressing the emotion of fear. Participants also completed the childhood trauma questionnaire (CTQ) and a structured clinical interview. Between-group differences in brain activation to fearful faces were limited to decreased activation in the BPD group in the right cuneus. However, within the BPD group, there was a significant positive correlation between physical abuse scores on the CTQ and BOLD signal in the midbrain, pulvinar and medial frontal gyrus to fearful (versus neutral) faces. In addition there was a significant correlation between midbrain activation and reported psychotic symptoms in the BPD group (Pmidbrain in response to emotional stimuli. Sustained differences in the response of the midbrain to emotional stimuli in individuals with BPD who suffered childhood physical abuse may underlie the vulnerability of these patients to developing psychotic symptoms.
Andrewes, Holly E; Hulbert, Carol; Cotton, Susan M; Betts, Jennifer; Chanen, Andrew M
Non-suicidal self-injury (NSSI) is a prevalent behaviour among people with borderline personality disorder (BPD) but many aspects of the emotional changes that trigger and maintain this behaviour are unknown. This study examines the relationships between NSSI and the number of negative ('negative complex') and opposing valence ('conflicting') emotions. One hundred and seven youth (aged 15-25 years) with first-presentation BPD were assessed using a combination of self-report and ecological momentary assessment to investigate trait levels of emotional acceptance and in vivo changes in the number of negative complex and conflicting emotions before and after self-injurious thoughts and behaviours. Multilevel modelling revealed that changes in the number of negative complex emotions mirrored distress levels before and after self-injurious thoughts and behaviours, approximating a quadratic curve. Increases in the number of negative complex emotions reported prior to self-injurious thoughts and behaviours were associated with lower acceptance of negative emotions. These findings indicate that the number of negative emotions experienced contributes to distress prior to engagement in NSSI. The relationship between non-acceptance of negative emotions and negative complex emotions prior to NSSI suggests that improved emotional awareness and acceptance should be a focus for early interventions aimed at reducing self-injury.
Bray, Stephanie; Barrowclough, Christine; Lobban, Fiona
Interventions for people suffering from borderline personality disorder (BPD), such as dialectical behaviour therapy, often include a problem-solving component. However, there is an absence of published studies examining the problem-solving abilities of this client group. In this study, the social problem-solving (SPS) abilities of three groups of participants were assessed: a BPD group (n=25), a clinical control (CC) group (n=25) procedure and a non-clinical control (NCC) group (n=25). SPS ability was assessed using the means-end problem-solving (MEPS) procedure and the Social Problem-Solving Inventory-Revised (SPSI-R). The BPD group exhibited deficits in their SPS abilities, however the majority of these deficits were not specific to the BPD group but were also found in the CC group, indicating that a common factor between these two groups, such as negative affect, may account for these observed deficits. Specific SPS deficits were identified in the BPD group: they provided less specific solutions on the MEPS and reported higher levels of negative problem orientation and a more impulsive/carelessness style towards solving social problems. The results of this study provide empirical support for the use of problem-solving interventions with people suffering from BPD.
Tadić, André; Baskaya, Omur; Victor, Anja; Lieb, Klaus; Höppner, Wolfgang; Dahmen, Norbert
Borderline personality disorder (BPD) is a serious psychiatric disorder affecting about 1-2% of the general population. Key features of BPD are emotional instability, strong impulsivity, repeated self-injurious behavior (SIB) and dissociation. In the etiology of BPD and its predominant symptoms, genetic factors have been suggested. The voltage-gated sodium channel Nav1.7 is expressed in sensory neurons and in the hippocampus, a key region of the limbic system probably dysfunctional in BPD and dissociative disorders. The alpha-subunit of Nav1.7 is encoded by the SCN9A gene on chromosome 2 and variations of SCN9A can lead to complete inability to sense pain. The aim of the present study was to test for associations between SCN9A gene variants and BPD as well as BPD-related phenotypes. We genotyped ten tagging single nucleotide polymorphisms (SNPs) within the SCN9A gene in 161 well-defined Caucasian BPD patients and 156 healthy controls. We found no globally significant association of SCN9A markers with BPD at level 5%. However, in the female and in the male subsample, different SCN9A markers and individual haplotypes showed uncorrected p-valuesSCN9A markers and dissociative symptoms. Although our results were largely negative, replication studies in an independent sample are warranted to follow up on the potential role of SCN9A gene variants in BPD and dissociative symptoms, paying special attention to a possible gender different etiology.
Full Text Available Antipsychotics are recommended for the treatment of impulsive dyscontrol and cognitive perceptual symptoms of borderline personality disorder (BPD. Three reports supported the efficacy of oral risperidone on BPD psychopathology. Paliperidone ER is the metabolite of risperidone with a similar mechanism of action, and its osmotic release reduces plasmatic fluctuations and antidopaminergic effects. The aim of this study is to evaluate efficacy and safety of paliperidone ER in BPD patients. 18 outpatients with a DSM-IV-TR diagnosis of BPD were treated for 12 weeks with paliperidone ER (3–6 mg/day. They were assessed at baseline, week 4, and week 12, using the CGI-Severity item, the BPRS, the HDRS, the HARS, the SOFAS, the BPD Severity Index (BPDSI, and the Barratt Impulsiveness Scale (BIS-11. Adverse events were evaluated with the DOTES. Paliperidone ER was shown to be effective and well tolerated in reducing severity of global symptomatology and specific BPD symptoms, such as impulsive dyscontrol, anger, and cognitive-perceptual disturbances. Results need to be replicated in controlled trials.
Full Text Available Background: There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD is distinct from Borderline Personality Disorder (BPD when the latter is comorbid with PTSD. Objective: To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. Method: A latent class analysis (LCA was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD. Results: The LCA revealed four distinct classes of individuals: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness. Conclusions: Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.
Full Text Available This study provides the first genetic association examination of borderline personality disorder traits (BPD traits in children and adolescents (ages 9-15 using two independent samples of youth recruited from the general community. We tested the a priori hypothesis that the serotonin transporter promoter gene (5-HTTLPR would relate specifically to BPD traits in youth. This association was hypothesized based on prior genetic association research with BPD adults and theory positing that emotion dysregulation may be a core risk process contributing to BPD. Youth provided DNA via buccal cells. Both youth and a parent completed self-report measures assessing youth’s BPD traits and depressive symptoms. Results from both Study 1 (N = 242 and an independent replication sample of Study 2 (N = 144 showed that carriers of the short allele of 5-HTTLPR exhibited the highest levels of BPD traits. This relation was observed even after controlling for the substantial co-occurrence between BPD traits and depressive symptoms. This specific association between 5-HTTLPR and BPD traits among youth supports previous genetic associations with adults diagnosed with BPD and provides preliminary support for a developmental extension of etiological risk for BPD among youth.
Maike C. Herbort
Full Text Available Patients with borderline personality disorder (BPD frequently exhibit impulsive behavior, and self-reported impulsivity is typically higher in BPD patients when compared to healthy controls. Previous functional neuroimaging studies have suggested a link between impulsivity, the ventral striatal response to reward anticipation, and prediction errors. Here we investigated the striatal neural response to monetary gain and loss anticipation and their relationship with impulsivity in 21 female BPD patients and 23 age-matched female healthy controls using functional magnetic resonance imaging (fMRI. Participants performed a delayed monetary incentive task in which three categories of objects predicted a potential gain, loss, or neutral outcome. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11. Compared to healthy controls, BPD patients exhibited significantly reduced fMRI responses of the ventral striatum/nucleus accumbens (VS/NAcc to both reward-predicting and loss-predicting cues. BIS-11 scores showed a significant positive correlation with the VS/NAcc reward anticipation responses in healthy controls, and this correlation, while also nominally positive, failed to reach significance in BPD patients. BPD patients, on the other hand, exhibited a significantly negative correlation between ventral striatal loss anticipation responses and BIS-11 scores, whereas this correlation was significantly positive in healthy controls. Our results suggest that patients with BPD show attenuated anticipation responses in the VS/NAcc and, furthermore, that higher impulsivity in BPD patients might be related to impaired prediction of aversive outcomes.
Full Text Available Background and Objectives: Previous studies reported a high prevalence of nightmares and dream anxiety in Borderline Personality Disorder (BPD and the severity of dream disturbances correlated with daytime symptoms of psychopathology. However, the majority of these results are based on retrospective questionnaire-based study designs, and hence the effect of recall biases (characteristic for BPD, could not be controlled. Therefore our aim was to replicate these findings using dream logs. Moreover, we aimed to examine the level of dream disturbances in connection with measures of emotional instability, and to explore the protective factors against dream disturbances. Methods: 23 subjects diagnosed with BPD, and 23 age and gender matched healthy controls were assessed using the Dream Quality Questionnaire, the Van Dream Anxiety Scale, as well as the Neuroticism, Assertiveness and Fantasy scales of the NEO-PI-R questionnaire. Additionally, subjects were asked to collect 5 dreams in the three-week study period and to rate the emotional and phenomenological qualities of the reported dreams using the categories of the Dream Quality Questionnaire. Results: Dream disturbances (nightmares, bad dreams, night terror-like symptoms, and dream anxiety were more frequent in patients with BPD than in controls. Dream disturbances correlated positively with Neuroticism, while Fantasy proved to be a negative correlate of dream disturbances. Conclusions: Our study provides further support for the association between dream disturbances and BPD, links the presence of dream disturbances to the levels of emotional instability, and suggests that fantasy is a potential protective factor against dysfunctional dreaming.
Full Text Available Previous research has suggested that patients meeting criteria for borderline personality disorder (BPD display altered self-related information processing. However, experimental studies on dysfunctional self-referential information processing in BPD are rare. In this study, BPD patients (N = 30 and healthy control participants (N = 30 judged positive, neutral, and negative words in terms of emotional valence. Referential processing was manipulated by a preceding self-referential pronoun, an other-referential pronoun, or no referential context. Subsequently, patients and participants completed a free recall and recognition task. BPD patients judged positive and neutral words as more negative than healthy control participants when the words had self-reference or no reference. In BPD patients, these biases were significantly correlated with self-reported attributional style, particularly for negative events, but unrelated to measures of depressive mood. However, BPD patients did not differ from healthy control participants in a subsequent free recall task and a recognition task. Our findings point to a negative evaluation bias for positive, self-referential information in BPD. This bias did not affect the storage of information in memory, but may be related to self-attributions of negative events in everyday life in BPD.
Amad, Ali; Ramoz, Nicolas; Thomas, Pierre; Jardri, Renaud; Gorwood, Philip
Borderline personality disorder (BPD) is one of the most common mental disorders and is characterized by a pervasive pattern of emotional lability, impulsivity, interpersonal difficulties, identity disturbances, and disturbed cognition. Here, we performed a systematic review of the literature concerning the genetics of BPD, including familial and twin studies, association studies, and gene-environment interaction studies. Moreover, meta-analyses were performed when at least two case-control studies testing the same polymorphism were available. For each gene variant, a pooled odds ratio (OR) was calculated using fixed or random effects models. Familial and twin studies largely support the potential role of a genetic vulnerability at the root of BPD, with an estimated heritability of approximately 40%. Moreover, there is evidence for both gene-environment interactions and correlations. However, association studies for BPD are sparse, making it difficult to draw clear conclusions. According to our meta-analysis, no significant associations were found for the serotonin transporter gene, the tryptophan hydroxylase 1 gene, or the serotonin 1B receptor gene. We hypothesize that such a discrepancy (negative association studies but high heritability of the disorder) could be understandable through a paradigm shift, in which "plasticity" genes (rather than "vulnerability" genes) would be involved. Such a framework postulates a balance between positive and negative events, which interact with plasticity genes in the genesis of BPD.
Peters, Jessica R; Geiger, Paul J
Shame has emerged as a particularly relevant emotion to the maintenance and exacerbation of borderline personality disorder (BPD) features; however, little attention has been paid to the potentially differing effects of other forms of self-conscious affect. While guilt has been demonstrated to have adaptive functions in the social psychology literature, it has not been previously explored whether a lack of socially adaptive guilt might also contribute to BPD-related dysfunction. The present study examined the relationship between BPD features and self-conscious emotions in a sample of undergraduate students (n = 839). Increased shame and decreased guilt independently accounted for significant variance in the association between BPD features and anger, hostility, and externalization of blame. Only increased shame significantly mediated the association between BPD features and anger rumination, and only decreased guilt significantly mediated the relationship between BPD features and aggression. These findings suggest BPD and its associated problems with anger and externalizing may be characterized not only by high levels of shame, but also by lower levels of guilt. Clinical implications include the need to differentiate between self-conscious emotions and teach adaptive responses to warranted guilt. (PsycINFO Database Record
Agnew, Gillian; Shannon, Ciarán; Ryan, Tina; Storey, Lesley
Identity disturbance has been suggested to be a core feature of borderline personality disorder (BPD). However, there is little known about the identity of individuals with symptoms of BPD from the participant's perspective. This study availed of in-depth lightly structured life story interviews with five female participants. Thematic analysis was utilized to derive three themes of identity: connection, distance between us, and hurt and healing. Results provided support for multiple and flexible conceptualizations of identity in comparison to the idea of a unitary self/identity. Results also suggested that participants were able to establish differing connections to others ranging from disconnection to intimacy and care. Participants reported that their identities were impacted upon by historical and current family/relationship dysfunction, but life stories also illustrated the positive impact of healing relationship experiences. Findings provide support for psychological theories that consider a multiple and relational self/identity and the empowerment of healthy aspects of the self in BPD recovery. Studies that assess the association between insight and change may further our knowledge into this complex population. PMID:27015876
Bellino, Silvio; Bozzatello, Paola; Bogetto, Filippo
Borderline personality disorder (BPD) is characterized by affective instability, impulsive behaviors, and disturbed interpersonal relationships. A previous study of our group found that combined therapy with interpersonal psychotherapy adapted to BPD (IPT-BPD) and fluoxetine was superior to single pharmacotherapy in BPD patients. The aim of the present study was to examine what clinical factors predicted response to combined therapy in patients evaluated in the previous efficacy study. The subgroup of 27 patients allocated to combined therapy was analyzed. Patients were treated for 32 weeks with fluoxetine 20-40 mg/day plus IPT-BPD. Patients were assessed at baseline and week 32 with an interview for demographic and clinical variables, CGI-S, HDRS, HARS, SOFAS, BPDSI, and SAT-P. Statistical analysis was performed with multiple regression. The difference of CGI-S score between baseline and week 32 (∆CGI-S) was the dependent variable. Factors significantly and independently related to ∆CGI-S were the BPDSI total score and the items abandonment, affective instability, and identity. Patients with more severe BPD psychopathology and with a higher degree of core symptoms such as fear of abandonment, affective instability, and identity disturbance have a better chance to improve with combined therapy with fluoxetine and IPT-BPD.
Leppänen, Virpi; Kärki, Anna; Saariaho, Tom; Lindeman, Sari; Hakko, Helinä
Borderline personality disorder (BPD) is a relatively common and severe psychiatric disorder that can impair quality of life in many ways. The aim of this study was to determine whether a combined treatment model for BPD patients, utilising major principles from schema-focused therapy (SFT) and dialectical behavioral therapy (DBT), could be more effective in relieving early maladaptive schemas of BPD patients, compared to treatment as usual (TAU). This study is a part of the Oulu BPD study conducted at mental health care services run by Oulu city social and health care services. The study is a multisite, randomized controlled trial conducted over a one year period, involving two groups of patients with severe BPD: (1) Community Treatment By Experts (CTBE) patients (n = 18) receiving the combined treatment model, and 2) TAU patients (n = 27). The patients' schemas were assessed using the Young Schema Questionnaire (YSQ-L3a) before and after one year of treatment. The results reveal that CTBE patients who attended the combined treatment model showed a statistically significant reduction in eight out of 18 early maladaptive schemas, while patients receiving treatment as usual did not demonstrate any significant changes in schemas. The cognitive therapeutic treatment model can be applied for clinical use in public mental health settings using existing professionals, and appears to produce positive changes in patients with BPD.
Carpenter, Ryan W; Trull, Timothy J
Individuals with borderline personality disorder (BPD), compared to controls, report a relative absence of acute pain. In contrast, BPD is overrepresented among chronic pain patients, suggesting they experience a relative excess of chronic pain. To date, this "pain paradox" has been only partially explored; no study has examined both acute and chronic pain in the same sample. In addition, previous research has not fully examined the effect of nonsuicidal self-injury (NSSI) on either acute or chronic pain experience in BPD. Undergraduates (N = 206), oversampled for those high in BPD features, completed a Cold Pressor Task (CPT), rating their pain every 15 s over a maximum of 4 min. Following the CPT, participants completed measures of BPD features, NSSI history, past-year pain, and perceived pain tolerance. Results did not support the expected negative association between BPD features and acute pain. Multilevel modeling revealed an interaction of BPD features and NSSI history on CPT pain ratings: Among individuals in the no-NSSI group, BPD features were associated with greater acute pain. Among individuals in the NSSI group, BPD features were not significantly associated with acute pain. Results for past-year pain indicated that BPD features were associated with greater past-year pain regardless of NSSI history. This finding, coupled with the difference in the association of BPD features and acute pain between the NSSI and no-NSSI groups provides tentative evidence that the combination of BPD features and NSSI history, among nonclinical samples, is linked to a pain paradox.
Peters, Jessica R; Geiger, Paul J; Smart, Laura M; Baer, Ruth A
Two prominent emotions in borderline personality disorder (BPD) are shame and anger. Rumination has been demonstrated to occur in response to shame and to escalate anger, and rumination, particularly anger rumination, has been shown to predict BPD symptoms. The present study tested a structural equation model in which shame leads to the features of BPD via increased anger and anger rumination. A sample of 823 undergraduates completed self-report measures of shame, trait-level anger, anger rumination, and BPD features. The hypothesized model of shame to anger and anger rumination to BPD features was largely supported. Bootstrapping was used to establish significant indirect effects from both situational and global forms of shame via anger rumination to BPD features, and from global shame via anger to most BPD features. The alternative hypothesis that anger and anger rumination contribute to BPD features via increased shame was also examined, with no significant indirect effects found. Recognizing this function of anger and anger rumination may be important in understanding the relationship between shame-proneness and BPD features and may have implications for treatment. Further research into determining other ways individuals maladaptively respond to shame, and understanding the functions of anger and anger rumination, is recommended.
Full Text Available Background The aim of this study was to broaden the understanding of the emotional difficulties of borderline personality organization (BPO by reference to a meta-ability named ‘orientation on the internal world’, here conceptualized as mentalization and mindfulness, in the framework of object relation theory. It was assumed that it is not mentalization “in itself”, but mainly its regulatory function, that is important for BPO. Participants and procedure The clinical and control groups (30 individuals each were examined using The Mental States Task, The Difficulties of Emotion Regulation Scale and The Mindful Attention Awareness Scale. Results Individuals with BPO functioned worse than the control group in terms of mentalization, mindfulness, and emotion regulation. The relationship between BPO and the meta-abilities was mediated by emotional dysregulation: total mediation was revealed for one mentalization dimension, and partial mediation was observed for mindfulness. Conclusions Orientation on emotional experience and emotional dysregulation are not independent predictors of BPO, but they can be treated as levels in the hierarchical model. Mentalization determines and influences emotion regulation in BPO.
Baez, Sandra; Marengo, Juan; Perez, Ana; Huepe, David; Font, Fernanda Giralt; Rial, Veronica; Gonzalez-Gadea, María Luz; Manes, Facundo; Ibanez, Agustin
Impaired social cognition has been claimed to be a mechanism underlying the development and maintenance of borderline personality disorder (BPD). One important aspect of social cognition is the theory of mind (ToM), a complex skill that seems to be influenced by more basic processes, such as executive functions (EF) and emotion recognition. Previous ToM studies in BPD have yielded inconsistent results. This study assessed the performance of BPD adults on ToM, emotion recognition, and EF tasks. We also examined whether EF and emotion recognition could predict the performance on ToM tasks. We evaluated 15 adults with BPD and 15 matched healthy controls using different tasks of EF, emotion recognition, and ToM. The results showed that BPD adults exhibited deficits in the three domains, which seem to be task-dependent. Furthermore, we found that EF and emotion recognition predicted the performance on ToM. Our results suggest that tasks that involve real-life social scenarios and contextual cues are more sensitive to detect ToM and emotion recognition deficits in BPD individuals. Our findings also indicate that (a) ToM variability in BPD is partially explained by individual differences on EF and emotion recognition; and (b) ToM deficits of BPD patients are partially explained by the capacity to integrate cues from face, prosody, gesture, and social context to identify the emotions and others' beliefs.
Lawrence, Katherine A; Chanen, Andrew M; Allen, J Sabura
The experience of rejection or abandonment in Borderline Personality Disorder (BPD) can lead to profound changes in affect. Yet, the intensity, duration, and type of mood changes that occur in response to rejection remain unclear. This study examined the effect of ostracism upon mood in 30 outpatient youth diagnosed with BPD and 22 healthy community control participants (aged 15-24). Cyberball, a virtual balltoss game, was used to simulate ostracism and 13 mood states were recorded before, immediately after, and 15 minutes after the game. The results showed that while ostracism induced changes in anger, rejection, surprise, suspicion, and joy, there were no differences in the pattern of emotional responding and regulation between the two groups. The BPD group consistently rated their mood as more intense across all 13 mood states and across time compared with the control group. These findings suggest that, compared to healthy individuals, those youth with BPD experience negative emotions as more intense and that in mild cases of interpersonal rejection, their emotional responding and regulation are similar to their healthy peers.
Penfold, Sarah; St. Denis, Emily
Background Overlap of aetiological factors and demographic characteristics with clinical observations of comorbidity has been documented in fibromyalgia syndrome, chronic fatigue syndrome (CFS) and borderline personality disorder (BPD). Aims The purpose of this study was to assess the association of BPD with fibromyalgia syndrome and CFS. The authors reviewed literature on the prevalence of BPD in patients with fibromyalgia or CFS and vice versa. Methods A search of five databases yielded six eligible studies. A hand search and contact with experts yielded two additional studies. We extracted information pertaining to study setting and design, demographic information, diagnostic criteria and prevalence. Results We did not identify any studies that specifically assessed the prevalence of fibromyalgia or CFS in patients with BPD. Three studies assessed the prevalence of BPD in fibromyalgia patients and reported prevalence of 1.0, 5.25 and 16.7%. Five studies assessed BPD in CFS patients and reported prevalence of 3.03, 1.8, 2.0, 6.5 and 17%. Conclusions More research is required to clarify possible associations between BPD, fibromyalgia and CFS. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:27703787
Perroud, Nader; Dieben, Karen; Nicastro, Rosetta; Muscionico, Michel; Huguelet, Philippe
The purpose of this study was to examine the meanings and timescale of self-cuttings in a cohort of 22 outpatients suffering from borderline personality disorder. Sixty-one events were recorded using the newly developed self-cutting-checklist (SCUC) designed to investigate the severity of self-cuttings, and intent to die, suicidal ideation, inner tension, sense of relief and anesthesia, and consequences associated with this behavior. We found that typical self-cuttings were associated with a decrease in inner tension and suicidal ideation. Moreover self-cuttings associated with a desire to die differentiated from those associated with no desire to die by significantly less reduction in inner tension. Finally, self-cuttings occurred significantly more often during evenings and nights than during daytime. In conclusion, self-cuttings can be reasonably addressed by self-report. Attention to specific issues such as intent to die and the time of the self-cuttings may improve the outcome of these particularly high-risk subjects.
Full Text Available The biological underpinnings of borderline personality disorder (BPD and its psychopathology including states of aversive tension and dissociation is poorly understood. Our goal was to examine transcriptional changes associated with states of tension or dissociation within individual patients in a pilot study. Dissociation is not only a critical symptom of BPD but has also been associated with higher risk for self-mutilation and depression. We conducted a whole blood gene expression profile analysis using quantitative PCR in 31 female inpatients with BPD. For each individual, two samples were drawn during a state of high tension and dissociation, while two samples were drawn at non-tension states. There was no association between gene expression and tension states. However, we could show that Interleukin-6 was positively correlated to dissociation scores, whereas Guanine nucleotide-binding protein G(s subunit alpha isoforms, Mitogen-activated protein kinase 3 and 8, Guanine nucleotide-binding protein G(i subunit alpha-2, Beta-arrestin-1 and 2, and Cyclic AMP-responsive element-binding protein were negatively correlated to dissociation. Our data point to a potential association of dissociation levels with the expression of genes involved in immune system regulation as well as cellular signalling/second-messenger systems. Major limitations of the study are the the possibly heterogeneous cell proportions in whole blood and the heterogeneous medication.
Huỳnh, Christophe; Guilé, Jean-Marc; Breton, Jean-Jacques; Godbout, Roger
Sleep-wake patterns are rarely examined in adolescents with borderline personality disorder (BPD) or bipolar disorder (BD). Within a developmental perspective, this study explores the sleep-wake cycle of adolescents aged 12-17 years with BPD or BD and healthy controls (HC) during periods with and without entrainment by school/work schedules. Eighteen euthymic BPD, six euthymic BD, and 20 HC adolescents wore wrist actigraphy during nine consecutive days to assess sleep-wake patterns. During school/work days, BPD adolescents spent more time awake when they were in bed compared to HC and BD adolescents (p = 0.039). On schedule-free days, BPD and BD youths spent more time in bed compared to HC adolescents (p = 0.015). BPD adolescents woke up over 1 h later compared to HC (p = 0.003). Total sleep time was more variable between nights in BPD adolescents compared to the HC group (p = 0.031). Future research should explore if sleep-wake pattern disruptions are a cause or a consequence of BPD symptomatology in adolescents. Addressing sleep-wake pattern during clinical assessment and treatment of BPD adolescents may potentially reduce their symptoms; this therapeutic effect still needs to be evaluated.
Simor, Péter; Horváth, Klára
The aim of the study was to review the literature regarding sleep disturbances in Borderline Personality Disorder (BPD) and to relate the reported sleep alterations to the underlying core dimensions of BPD pathology. We present a qualitative and theoretical review regarding the empirical studies that investigated objective and subjective sleep quality in BPD and in different psychiatric conditions showing high co-morbidity with this disorder. We show that disturbed sleep including sleep fragmentation, alterations in Slow Wave Sleep and REM sleep, and dysphoric dreaming are prevalent symptoms in BPD. We provide a framework relating the specific sleep alterations to the core dimensions of BPD pathology in order to clarify the inconsistencies of the different findings. The specific sleep disturbances in BPD seem to be related to different dimensions of psychopathological functioning and may have detrimental consequences on waking affect and cognition. Investigating disturbed sleep in BPD in relation to waking symptoms and underlying neural functioning would shed more light on the nature of this complex disorder. Moreover, a stronger emphasis on sleep disturbances would enrich the treatment protocols of BPD.
Ruocco, Anthony C; Carcone, Dean
Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder's complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging. We consolidate the results of these studies and provide an integrative model that attempts to incorporate the heterogeneous findings. The model specifies interactions among endogenous stress hormones, neurometabolism, and brain structures and circuits involved in emotion and cognition. The role of the amygdala in BPD is expanded to consider its functions in coordinating the brain's dynamic evaluation of the relevance of emotional stimuli in the context of an individual's goals and motivations. Future directions for neurobiological research on BPD are discussed, including implications for the Research Domain Criteria framework, accelerating genetics research by incorporating endophenotypes and gene × environment interactions, and exploring novel applications of neuroscience findings to treatment research.
De Panfilis, Chiara; Riva, Paolo; Preti, Emanuele; Cabrino, Chiara; Marchesi, Carlo
Increasing evidence suggests that individuals with borderline personality disorder (BPD) might feel rejected even when socially included by others. A psychological mechanism accounting for this response bias could be that objective social inclusion violates BPD patients' underlying implicit needs of "extreme" inclusion. Thus, this study investigated whether, during interpersonal exchanges, BPD patients report more rejection-related negative emotions and less feelings of social connection than controls unless they are faced with conditions of extreme social inclusion. Sixty-one BPD patients and 61 healthy controls completed a modified Cyberball paradigm. They were randomly assigned to a condition of ostracism, social inclusion, or overinclusion (a proxy for extreme social inclusion). They then rated their emotional states and feelings of social connection immediately and 20 min after the game. BPD patients reported greater levels of negative emotions than controls in the ostracism and the inclusion conditions, but not when overincluded. Furthermore, only for BPD participants was overinclusion associated with experiencing less negative emotions than the ostracism condition. However, BPD patients reported lower feelings of social connection than controls in any experimental situation. Thus, in BPD, a laboratory condition of "overinclusion" is associated with a reduction of negative emotions to levels comparable to those of control participants, but not with similar degrees of social connection. These results suggest that for BPD patients, even "including contexts" activate feelings of rejection. Their implicit expectations of idealized interpersonal inclusion may nullify the opportunity of experiencing "real" social connection and explain their distorted subjective experiences of rejection.
Beeney, Joseph E; Hallquist, Michael N; Clifton, Allan D; Lazarus, Sophie A; Pilkonis, Paul A
Examining differences in social integration, social support, and relationship characteristics in social networks may be critical for understanding the character and costs of the social difficulties experienced of borderline personality disorder (BPD). We conducted an ego-based (self-reported, individual) social network analysis of 142 participants recruited from clinical and community sources. Each participant listed the 30 most significant people (called alters) in their social network, then rated each alter in terms of amount of contact, social support, attachment strength and negative interactions. In addition, measures of social integration were determined using participant's report of the connection between people in their networks. BPD was associated with poorer social support, more frequent negative interactions, and less social integration. Examination of alter-by-BPD interactions indicated that whereas participants with low BPD symptoms had close relationships with people with high centrality within their networks, participants with high BPD symptoms had their closest relationships with people less central to their networks. The results suggest that individuals with BPD are at a social disadvantage: Those with whom they are most closely linked (including romantic partners) are less socially connected (i.e., less central) within their social network. (PsycINFO Database Record
De la Fuente, José Manuel; Bengoetxea, Endika; Navarro, Felipe; Bobes, Julio; Alarcón, Renato Daniel
There is agreement in that strengthening the sets of neurobiological data would reinforce the diagnostic objectivity of many psychiatric entities. This article attempts to use this approach in borderline personality disorder (BPD). Assuming that most of the biological findings in BPD reflect common underlying pathophysiological processes we hypothesized that most of the data involved in the findings would be statistically interconnected and interdependent, indicating biological consistency for this diagnosis. Prospectively obtained data on scalp and sleep electroencephalography (EEG), clinical neurologic soft signs, the dexamethasone suppression and thyrotropin-releasing hormone stimulation tests of 20 consecutive BPD patients were used to generate a Bayesian network model, an artificial intelligence paradigm that visually illustrates eventual associations (or inter-dependencies) between otherwise seemingly unrelated variables. The Bayesian network model identified relationships among most of the variables. EEG and TSH were the variables that influence most of the others, especially sleep parameters. Neurological soft signs were linked with EEG, TSH, and sleep parameters. The results suggest the possibility of using objective neurobiological variables to strengthen the validity of future diagnostic criteria and nosological characterization of BPD.
Karamanolaki, Hara; Spyropoulou, Areti C; Iliadou, Aggeliki; Vousoura, Eleni; Vondikaki, Stamatia; Pantazis, Nikos; Vaslamatzis, Grigoris
The purpose of this study was to assess the possible effect of recalled traumatic experiences, perceived parental rearing styles, and family parameters on the occurrence of borderline personality disorder (BPD) versus other personality disorders (other-PDs). A total of 88 adult outpatients with personality disorders completed the Traumatic Antecedents Questionnaire and the Egna Minnen av Barndoms Uppfostran, which measures perceptions regarding parental rearing. Results indicated that incidence of traumatic childhood experiences was higher among those in the BPD group compared to those in the other-PD group. Firstborns were less likely to carry a diagnosis of BPD over other-PDs. Also, significantly more BPD compared to other-PD patients reported being the father's favorite child over siblings. Results suggest that traumatic experiences, birth order, and family interactions in the presence of siblings seem to differentially affect the formation of borderline diagnosis compared to other-PDs. Limitations and clinical implications of the study are discussed in detail.
Full Text Available CONTEXTO: Evidências apontam que adolescentes infratores graves (autores de homicídio, estupro e latrocínio possuem personalidade psicopática e risco aumentado de reincidência criminal, mas não apresentam maior prevalência de história de abuso na infância do que outros adolescentes infratores. OBJETIVO: Comparar a psicopatia, a reincidência criminal e a história de maus-tratos entre adolescentes infratores versus a vida e outros adolescentes infratores. MÉTODO: Estudo transversal, controlado, utilizando a escala Hare's Psychopathy Checklist Revised (PCL-R para avaliação de psicopatia em uma amostra de adolescentes cumprindo medida socioeducativa em decorrência da prática de ato infracional. RESULTADOS: Os adolescentes que cometeram crimes contra a vida apresentaram prevalência de psicopatia maior do que outros adolescentes infratores - RP = 2,86 (IC95% 1,49-5,47. A reincidência criminal foi mais prevalente entre os adolescentes que possuíam psicopatia e história de crimes contra a vida - RP = 2,96 (IC95% 1,32-6,60. O estudo não conseguiu demonstrar prevalência significativa de história de abuso na infância entre os adolescentes com psicopatia em comparação ao grupo-controle - RP = 0,88 (IC95% 0,66-1,15. CONCLUSÕES: Os resultados sugerem prevalência aumentada de personalidade psicopática e reincidência criminal entre os adolescentes autores de crimes contra a vida quando comparados a outros adolescentes infratores.BACKGROUND: Evidences point out that the young offenders involved with major crimes (such as homicide, rape and violent robbery have psychopathic personality, with greater risk of recidivism but do not have a higher prevalence of childhood abuse history compared to other young delinquents. OBJECTIVE: To compare the psychopathy, criminal recidivism. However, incidence of childhood abuse is similar to other young delinquents groups. METHODS: Cross-sectional study, controlled, using the Hare's Psychopathy
Lynam, Donald R.; Gaughan, Eric T.; Miller, Joshua D.; Miller, Drew J.; Mullins-Sweatt, Stephanie; Widiger, Thomas A.
A new self-report assessment of the basic traits of psychopathy was developed with a general trait model of personality (five-factor model [FFM]) as a framework. Scales were written to assess maladaptive variants of the 18 FFM traits that are robustly related to psychopathy across a variety of perspectives including empirical correlations, expert…
Bach, B; Sellbom, M; Bo, S
to determine how the alternative DSM-5 Section III personality trait dimensions differentiates such features in BPD patients versus comparison groups. To date, no study has attempted such validation. METHOD: The current study examined the utility of the DSM-5 trait dimensions in differentiating patients...... with the categorical DSM-IV/5 diagnosis of BPD (n=101) from systematically matched samples of other PD patients (n=101) and healthy controls (n=101). This was investigated using one-way ANOVA and multinomial logistic regression analyses. RESULTS: Results indicated that Emotional Lability, Risk Taking...
Schuppert, H Marieke; Albers, Casper J; Minderaa, Ruud B; Emmelkamp, Paul M G; Nauta, Maaike H
The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress has not been examined in this group. The current study examined 101 adolescents (14-19 years old) with BPD symptoms and their mothers. Assessments were made on severity of BPD symptoms, youth-perceived maternal rearing styles, and psychopathology and parenting stress in mothers. Multiple regression analyses were used to examine potential predictors of borderline severity. No correlation was found between severity of BPD symptoms in adolescents and parenting stress. Only youth-perceived maternal overprotection was significantly related to BPD severity. The combination of perceived maternal rejection with cluster B traits in mothers was significantly related to BPD severity in adolescents. This study provides a contribution to the disentanglement of the developmental pathways that lead to BPD.
van Dijke, Annemiek; van 't Wout, Mascha; Ford, Julian D; Aleman, André
Although deficits in facial affect processing have been reported in schizophrenia as well as in borderline personality disorder (BPD), these disorders have not yet been directly compared on facial affect labeling. Using degraded stimuli portraying neutral, angry, fearful and angry facial expressions, we hypothesized more errors in labeling negative facial expressions in patients with schizophrenia compared to healthy controls. Patients with BPD were expected to have difficulty in labeling neutral expressions and to display a bias towards a negative attribution when wrongly labeling neutral faces. Patients with schizophrenia (N = 57) and patients with BPD (N = 30) were compared to patients with somatoform disorder (SoD, a psychiatric control group; N = 25) and healthy control participants (N = 41) on facial affect labeling accuracy and type of misattributions. Patients with schizophrenia showed deficits in labeling angry and fearful expressions compared to the healthy control group and patients with BPD showed deficits in labeling neutral expressions compared to the healthy control group. Schizophrenia and BPD patients did not differ significantly from each other when labeling any of the facial expressions. Compared to SoD patients, schizophrenia patients showed deficits on fearful expressions, but BPD did not significantly differ from SoD patients on any of the facial expressions. With respect to the type of misattributions, BPD patients mistook neutral expressions more often for fearful expressions compared to schizophrenia patients and healthy controls, and less often for happy compared to schizophrenia patients. These findings suggest that although schizophrenia and BPD patients demonstrate different as well as similar facial affect labeling deficits, BPD may be associated with a tendency to detect negative affect in neutral expressions.
Full Text Available Increasing evidence has documented subtle changes in brain morphology and function in patients with borderline personality disorder (BPD. However, results of magnetic resonance imaging volumetry in patients with BPD are inconsistent. In addition, few researchers using voxel-based morphometry (VBM have focused on attachment and childhood trauma in BPD. This preliminary study was performed to investigate structural brain changes and their relationships to attachment and childhood trauma in a homogenous sample of young adults with BPD.We examined 34 young adults with BPD and 34 healthy controls (HCs to assess regionally specific differences in gray matter volume (GMV and gray matter concentration (GMC. Multiple regressions between brain volumes measured by VBM and attachment style questionnaire (ASQ and childhood trauma questionnaire (CTQ scores were performed.Compared with HCs, subjects with BPD showed significant bilateral increases in GMV in the middle cingulate cortex (MCC/posterior cingulate cortex (PCC/precuneus. GMC did not differ significantly between groups. In multiple regression models, ASQ insecure attachment scores were correlated negatively with GMV in the precuneus/MCC and middle occipital gyrus in HCs, HCs with more severe insecure attachment showed smaller volumes in precuneus/MCC and middle occipital gyrus, whereas no negative correlations between insecure attachment and GMV in any region were found in BPD group. In addition, CTQ total scores were not correlated with GMV in any region in the two groups respectively.Our findings fit with those of previous reports of larger precuneus GMV in patients with BPD, and suggest that GMV in the precuneus/MCC and middle occipital gyrus is associated inversely with insecure attachment style in HCs. Our finding of increased GMV in the MCC and PCC in patients with BPD compared with HCs has not been reported in previous VBM studies.
Annemiek van Dijke
Full Text Available Although deficits in facial affect processing have been reported in schizophrenia as well as in borderline personality disorder (BPD, these disorders have not yet been directly compared on facial affect labeling. Using degraded stimuli portraying neutral, angry, fearful and angry facial expressions, we hypothesized more errors in labeling negative facial expressions in patients with schizophrenia compared to healthy controls. Patients with BPD were expected to have difficulty in labeling neutral expressions and to display a bias towards a negative attribution when wrongly labeling neutral faces. Patients with schizophrenia (N = 57 and patients with BPD (N = 30 were compared to patients with somatoform disorder (SoD, a psychiatric control group; N = 25 and healthy control participants (N = 41 on facial affect labeling accuracy and type of misattributions. Patients with schizophrenia showed deficits in labeling angry and fearful expressions compared to the healthy control group and patients with BPD showed deficits in labeling neutral expressions compared to the healthy control group. Schizophrenia and BPD patients did not differ significantly from each other when labeling any of the facial expressions. Compared to SoD patients, schizophrenia patients showed deficits on fearful expressions, but BPD did not significantly differ from SoD patients on any of the facial expressions. With respect to the type of misattributions, BPD patients mistook neutral expressions more often for fearful expressions compared to schizophrenia patients and healthy controls, and less often for happy compared to schizophrenia patients. These findings suggest that although schizophrenia and BPD patients demonstrate different as well as similar facial affect labeling deficits, BPD may be associated with a tendency to detect negative affect in neutral expressions.
Full Text Available Despite evidence suggesting that skills training is an important mechanism of change in dialectical behaviour therapy, little research exploring facilitators and barriers to this process has been conducted. The study aimed to explore clients' experiences of barriers to dialectical behaviour therapy skills training and how they felt they overcame these barriers, and to compare experiences between treatment completers and dropouts. In-depth qualitative interviews were conducted with 40 clients with borderline personality disorder who had attended a dialectical behaviour therapy programme. A thematic analysis of participants' reported experiences found that key barriers to learning the skills were anxiety during the skills groups and difficulty understanding the material. Key barriers to using the skills were overwhelming emotions which left participants feeling unable or unwilling to use them. Key ways in which participants reported overcoming barriers to skills training were by sustaining their commitment to attending therapy and practising the skills, personalising the way they used them, and practising them so often that they became an integral part of their behavioural repertoire. Participants also highlighted a number of key ways in which they were supported with their skills training by other skills group members, the group therapists, their individual therapist, friends and family. Treatment dropouts were more likely than completers to describe anxiety during the skills groups as a barrier to learning, and were less likely to report overcoming barriers to skills training via the key processes outlined above. The findings of this qualitative study require replication, but could be used to generate hypotheses for testing in further research on barriers to skills training, how these relate to dropout, and how they can be overcome. The paper outlines several such suggestions for further research.
Full Text Available Aim. The aim of the study was a relation between the borderline personality disorder and psychological gender, and tendency to use various manipulation tactics in everyday life and therapeutic context.Methods. The study used the Psychological Gender Inventory (A. Kuczyńska, 1992, and self-developed questionnaire for evaluating the tendency to use manipulation tactics and a survey evaluating manipulation in therapeutic contact. The studied group included: 30 patients with diagnosed BPD, 30 people a control group and 125 therapists.Results. The study of psychological gender showed that in the patient group the level of masculinity was significantly lower. Results showed that 88% of the therapists participating in the study confirmed that they have experienced manipulation attempts from patients. The therapists assessed the tendency of patientsto use manipulation tactics as greater than it was declared by the patients themselves. When compared to the control group, the patients indeed demonstrated a greater tendency to use the tactics of begging,threatening and threatening to break a close relationship and a lesser tendency to use the tactic of seduction. In the view of the therapists, during therapy patients most often used the tactics of lying and guilt induction.Conclusions. Manipulation is frequently used by BPD patients both in everyday life and in therapeutic contact. The most common reasons for using manipulation is to obtain benefits and to avoid negativeconsequences. It is necessary to conduct further research in this field and educate those who work with psychiatric patients in order to make them develop the ability to detect manipulation attempts and cope with such tactics.
Full Text Available Borderline personality disorder (BPD is characterized by stable instability of emotions and behavior and their regulation. This emotional and behavioral instability corresponds with a neurocognitive triple network model of psychopathology, which suggests that aberrant emotional saliency and cognitive control is associated with aberrant interaction across three intrinsic connectivity networks (ICN (i.e. the salience, default mode, and central executive network, SN, DMN, CEN. The objective of the current study was to investigate whether and how such triple network intrinsic functional connectivity (iFC is changed in patients with BPD. We acquired resting-state functional magnetic resonance imaging (rs-fMRI data from fourteen patients with BPD and sixteen healthy controls (HC. High-model order independent component analysis (ICA was used to extract spatiotemporal patterns of ongoing, coherent blood-oxygen-level-dependent (BOLD signal fluctuations from rs-fMRI data. Main outcome measures were iFC within networks (intra-iFC and between networks (i.e. network time course correlation inter-iFC.Aberrant intra-iFC was found in patients’ DMN, SN, and CEN, consistent with previous findings. While patients’ inter-iFC of the CEN was decreased, inter-iFC of the SN was increased. In particular, a balance index reflecting the relationship of CEN-and SN-inter-iFC across networks was strongly shifted from CEN to SN connectivity in patients. Results provide first preliminary evidence for aberrant triple network intrinsic functional connectivity in BPD. Our data suggest a shift of inter-network iFC from networks involved in cognitive control to those of emotion-related activity in BPD, potentially reflecting the persistent instability of emotion regulation in patients.
Austin, Marilyn A; Riniolo, Todd C; Porges, Stephen W
The current study provides the first published evidence that the parasympathetic component of the autonomic nervous system differentiates the response profiles between individuals diagnosed with borderline personality disorder (BPD) and controls. Respiratory sinus arrhythmia (RSA), a non-invasive marker of the influence of the myelinated vagal fibers on the heart, and heart period were collected during the presentation of film clips of varying emotional content. The BPD and control groups had similar initial levels of RSA and heart period. However, during the experiment the groups exhibited contrasting trajectories, with the BPD group decreasing RSA and heart period and the control group increasing RSA and heart period. By the end of the experiment, the groups differ significantly on both RSA and heart period. The correlation between the changes in RSA and heart period was significant only for the control group, suggesting that vagal mechanisms mediated the heart period responses only in the control group. The findings were consistent with the Polyvagal Theory [Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage: A Polyvagal Theory. Psychophysiology, 32, 301-318; Porges, S. W. (2001). The Polyvagal Theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42, 123-146; Porges, S. W. (2003). Social engagement and attachment: A phylogenetic perspective. Annals of the New York Academy of Sciences, 1008, 31-47.], illustrating different adaptive shifts in autonomic state throughout the course of the experiment. The BPD group ended in a physiological state that supports the mobilization behaviors of fight and flight, while the control group ended in a physiological state that supports social engagement behaviors. These finding are consistent with other published studies demonstrating atypical vagal regulation of the heart with other psychiatric disorders.
Barnicot, Kirsten; Couldrey, Laura; Sandhu, Sima; Priebe, Stefan
Despite evidence suggesting that skills training is an important mechanism of change in dialectical behaviour therapy, little research exploring facilitators and barriers to this process has been conducted. The study aimed to explore clients' experiences of barriers to dialectical behaviour therapy skills training and how they felt they overcame these barriers, and to compare experiences between treatment completers and dropouts. In-depth qualitative interviews were conducted with 40 clients with borderline personality disorder who had attended a dialectical behaviour therapy programme. A thematic analysis of participants' reported experiences found that key barriers to learning the skills were anxiety during the skills groups and difficulty understanding the material. Key barriers to using the skills were overwhelming emotions which left participants feeling unable or unwilling to use them. Key ways in which participants reported overcoming barriers to skills training were by sustaining their commitment to attending therapy and practising the skills, personalising the way they used them, and practising them so often that they became an integral part of their behavioural repertoire. Participants also highlighted a number of key ways in which they were supported with their skills training by other skills group members, the group therapists, their individual therapist, friends and family. Treatment dropouts were more likely than completers to describe anxiety during the skills groups as a barrier to learning, and were less likely to report overcoming barriers to skills training via the key processes outlined above. The findings of this qualitative study require replication, but could be used to generate hypotheses for testing in further research on barriers to skills training, how these relate to dropout, and how they can be overcome. The paper outlines several such suggestions for further research.
Hiraoka, Regina; Crouch, Julie L; Reo, Gim; Wagner, Michael F; Milner, Joel S; Skowronski, John J
The present study extends prior research examining the association between borderline personality disorder (BPD) features and child physical abuse (CPA) risk. We hypothesized that: (1) high CPA risk parents (compared to low CPA risk parents) would more often report clinically elevated levels of BPD features; (2) high CPA risk parents with elevated BPD features would represent a particularly high-risk subgroup; and (3) the association between elevated BPD features and CPA risk would be partially explained by emotion regulation difficulties. General population parents (N=106; 41.5% fathers) completed self-report measures of BPD features, CPA risk, and emotion regulation difficulties. Results support the prediction that BPD features are more prevalent among high (compared to low) CPA risk parents. Among the parents classified as high CPA risk (n=45), one out of three (33.3%) had elevated BPD features. In contrast, none of the 61 low CPA risk parents reported elevated BPD symptoms. Moreover, 100% of the parents with elevated BPD features (n=15) were classified as high-risk for CPA. As expected, high CPA risk parents with elevated BPD features (compared to high CPA risk parents with low BPD features) obtained significantly higher scores on several Child Abuse Potential Inventory scales, including the overall abuse scale (d=1.03). As predicted, emotion regulation difficulties partially explained the association between BPD features and CPA risk. Findings from the present study suggest that a subset of high CPA risk parents in the general population possess clinically significant levels of BPD symptoms and these parents represent an especially high-risk subgroup. Interventions designed to address BPD symptoms, including emotion regulation difficulties, appear to be warranted in these cases.
Both bipolar disorder and borderline personality disorder (BPD) are serious mental health disorders resulting in significant psychosocial morbidity, reduced health-related quality of life, and excess mortality. Yet research on BPD has received much less funding from the National Institute of Health (NIH) than has bipolar disorder during the past 25 years. Why hasn't the level of NIH research funding for BPD been commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder? In the present article, the author illustrates how the bipolar disorder research community has done a superior job of "marketing" their disorder. Studies of underdiagnosis, screening, diagnostic spectra, and economics are reviewed for both bipolar disorder and BPD. Researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, developed and promoted several screening scales, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these four issues and research efforts. Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than) bipolar disorder, and as lethal as (if not more lethal than) bipolar disorder, it has received less than one-tenth the level of funding from the NIH and has been the focus of many fewer publications in the most prestigious psychiatric journals. The researchers of BPD should consider adopting the strategy taken by researchers of bipolar disorder before the diagnosis is eliminated in a future iteration of the DSM or the ICD.
Poythress, Norman G.; Lilienfeld, Scott O.; Skeem, Jennifer L.; Douglas, Kevin S.; Edens, John F.; Epstein, Monica; Patrick, Christopher J.
Two self-report measures of psychopathy, Levenson's Primary and Secondary Psychopathy scales (LPSP) and the Psychopathic Personality Inventory (PPI), were administered to a large sample of 1,603 offenders. The most widely researched measure of criminal psychopathy, the Hare Psychopathy Checklist-Revised (PCL-R), served as a provisional referent…
Leichsenring, Falk; Kunst, Heike; Hoyer, Jürgen
Although theoretical assumptions and empirical evidence suggest an association between borderline personality disorder (BPD) and antisocial behavior or even antisocial personality disorder (APD), there is no study relating the psychodynamic aspects of BPD to antisocial behavior. In this study, the authors tested the correlation between the structural criteria of borderline personality organization (BPO)--that is, identity diffusion, primitive defense mechanisms, and reality testing--and antisocial features, neuroticism, and interpersonal problems. A sample of imprisoned violent offenders (N = 91) was studied using the Antisocial Personality Questionnaire (APQ), the Borderline Personality Inventory (BPI), the Neo-Five-Factor-Inventory (Neo-FFI), and the Inventory of Interpersonal Problems (IIP). Significant correlations were predicted and found between the BPI scales of identity diffusion, primitive defense mechanisms, impaired reality testing, and fear of closeness and antisocial features, neuroticism, agreeableness, and interpersonal problems. The results are consistent with both object relations theory and attachment theory.
Full Text Available Objective: Borderline personality disorder is one of the most complex and prevalent personality disorders. Many variables have so far been studied in relation to this disorder. This study aimed to investigate the role of emotion regulation, attachment styles, and theory of mind in predicting the traits of borderline personality disorder.Method: In this study, 85 patients with borderline personality disorder were selected using convenience sampling method. To measure the desired variables, the questionnaires of Gross emotion regulation, Collins and Read attachment styles, and Baron Cohen's Reading Mind from Eyes Test were applied. The data were analyzed using multivariate stepwise regression technique.Results: Emotion regulation, attachment styles, and theory of mind predicted 41.2% of the variance criterion altogether; among which, the shares of emotion regulation, attachment styles and theory of mind to the distribution of the traits of borderline personality disorder were 27.5%, 9.8%, and 3.9%, respectively.Conclusion: The results of the study revealed that emotion regulation, attachment styles, and theory of mind are important variables in predicting the traits of borderline personality disorder and that these variables can be well applied for both the treatment and identification of this disorder.
Ghiasi, Hamed; Mohammadi, Abolalfazl; Zarrinfar, Pouria
Objective: Borderline personality disorder is one of the most complex and prevalent personality disorders. Many variables have so far been studied in relation to this disorder. This study aimed to investigate the role of emotion regulation, attachment styles, and theory of mind in predicting the traits of borderline personality disorder. Method: In this study, 85 patients with borderline personality disorder were selected using convenience sampling method. To measure the desired variables, the questionnaires of Gross emotion regulation, Collins and Read attachment styles, and Baron Cohen's Reading Mind from Eyes Test were applied. The data were analyzed using multivariate stepwise regression technique. Results: Emotion regulation, attachment styles, and theory of mind predicted 41.2% of the variance criterion altogether; among which, the shares of emotion regulation, attachment styles and theory of mind to the distribution of the traits of borderline personality disorder were 27.5%, 9.8%, and 3.9%, respectively. Conclusion: The results of the study revealed that emotion regulation, attachment styles, and theory of mind are important variables in predicting the traits of borderline personality disorder and that these variables can be well applied for both the treatment and identification of this disorder.
Fossati, Andrea; Somma, Antonella; Borroni, Serena; Maffei, Cesare; Markon, Kristian E; Krueger, Robert F
To evaluate the associations between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5 (PID-5) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n = 49), b) BPD (n = 32), c) any other PD (n = 91), and d) no PD (n = 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5 traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.
Gacono, C B; Meloy, J R
This study utilized the Rorschach as a psychometric measure for understanding Antisocial Personality Disorder (American Psychiatric Association, 1987). Comprehensive System (Exner, 1986) Rorschach data for a sample of 60 ADP subjects and Rorschach object relations and defensive operations for 22 psychopathic APD (P-APD) and 21 nonpsychopathic APD (NP-APD) subjects are presented and discussed. The data support the absence of anxiety and attachment and the presence of pathological narcissism and borderline personality organization in P-APDs. The Rorschach's ability to differentiate antisocial groups based on level of psychopathy (Hare, 1980, 1985) strongly supports the need to use psychopathy as an independent measure when one is studying APD.
Patrícia Helena Vaz Tanesi
Full Text Available Adesão é um comportamento complexo, envolve desde pequenas recusas ao tratamento até o uso inadequado dos serviços de saúde e abandono do tratamento. O presente trabalho é um estudo qualitativo com seis pacientes com transtorno de personalidade borderline sobre adesão ao tratamento, utilizando análise qualitativa em entrevista aberta, questionário psicossocial, classificação diagnóstica pela SCID I e II e acompanhamento clínico. Os resultados mostraram que impulsividade, manipulação, dissociação afetiva, tentativa de suicídio, tendência à regressão e agressividade dificultaram ou impossibilitaram a adesão ao tratamento. Concluímos que os casos que abandonaram o tratamento colocaram a equipe em uma situação de impotência e apelo para estratégias sociais como forma de manejo da situação. É levantada a hipótese de que familiares saudáveis podem ser importantes para a adesão ao tratamento. Nos casos que não abandonaram o acompanhamento, a não-adesão se manifestou como ataques ao vínculo, ataques a melhora, e agressividade voltada à equipe e à instituição.Compliance is a complex behavior, ranging from minor instances of treatment refusal to the inappropriate use of health services or even treatment abandonment. The study comprises a qualitative analysis of six patients with borderline personality disorder submitted to an open interview, a psychosocial questionnaire, a diagnostic classification through SCDI I and II and a clinical follow-up. Six behaviors made treatment compliance either difficult or impossible: impulsivity, manipulation, affective dissociation, attempted suicide, tendency to regression, and aggression. The participants who abandoned the treatment made the health team impotent, requiring social strategies to manage the situation. We hypothesized that healthy families are of great importance for compliance to treatment. For the cases in which treatment was not abandoned, non-compliance was
Banny, Adrienne M; Tseng, Wan-Ling; Murray-Close, Dianna; Pitula, Clio E; Crick, Nicki R
The present longitudinal investigation examined borderline personality features as a predictor of aggression 1 year later. Moderation by physiological reactivity and gender was also explored. One hundred ninety-six children (M = 10.11 years, SD = 0.64) participated in a laboratory stress protocol in which their systolic blood pressure, diastolic blood pressure, and skin conductance reactivity to recounting a relational stressor (e.g., threats to relationships or exclusion) were assessed. Teachers provided reports on subtypes of aggressive behavior (i.e., reactive relational, proactive relational, reactive physical, and proactive physical), and children completed a self-report measure of borderline personality features. Path analyses indicated that borderline personality features predicted increases in reactive relational aggression and proactive relational aggression among girls who evinced heightened physiological reactivity to interpersonal stress. In contrast, borderline personality features predicted decreases in proactive physical aggression in girls. Findings suggest that borderline personality features promote engagement in relationally aggressive behaviors among girls, particularly in the context of emotional dysregulation.
Rogers, Megan L; Joiner, Thomas E
Borderline personality disorder diagnostic criteria, particularly affective dysregulation and behavioral dysregulation, are avenues through which suicide risk is conferred, though pathways are not well understood. The interpersonal theory of suicide may help elucidate these associations. The current study examined indirect relationships between affective and behavioral dysregulation and suicidal ideation through perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. 169 outpatients completed measures prior to their intake assessment. Perceived burdensomeness accounted for the relationship between affective dysregulation and suicidal ideation. The acquired capability did not explain the association between behavioral dysregulation and suicide attempt history. Affective and behavioral dysregulation may be key targets in treatment for reducing suicide risk.
Full Text Available There is a general agreement that physical pain serves as an alarm signal for the prevention of and reaction to physical harm. It has recently been hypothesized that "social pain," as induced by social rejection or abandonment, may rely on comparable, phylogenetically old brain structures. As plausible as this theory may sound, scientific evidence for this idea is sparse. This study therefore attempts to link both types of pain directly. We studied patients with borderline personality disorder (BPD because BPD is characterized by opposing alterations in physical and social pain; hyposensitivity to physical pain is associated with hypersensitivity to social pain, as indicated by an enhanced rejection sensitivity.Twenty unmedicated female BPD patients and 20 healthy participants (HC, matched for age and education played a virtual ball-tossing game (cyberball, with the conditions for exclusion, inclusion, and a control condition with predefined game rules. Each cyberball block was followed by a temperature stimulus (with a subjective pain intensity of 60% in half the cases. The cerebral responses were measured by functional magnetic resonance imaging. The Adult Rejection Sensitivity Questionnaire was used to assess rejection sensitivity.Higher temperature heat stimuli had to be applied to BPD patients relative to HCs to reach a comparable subjective experience of painfulness in both groups, which suggested a general hyposensitivity to pain in BPD patients. Social exclusion led to a subjectively reported hypersensitivity to physical pain in both groups that was accompanied by an enhanced activation in the anterior insula and the thalamus. In BPD, physical pain processing after exclusion was additionally linked to enhanced posterior insula activation. After inclusion, BPD patients showed reduced amygdala activation during pain in comparison with HC. In BPD patients, higher rejection sensitivity was associated with lower activation differences during
Bungert, Melanie; Koppe, Georgia; Niedtfeld, Inga; Vollstädt-Klein, Sabine; Schmahl, Christian
Objective There is a general agreement that physical pain serves as an alarm signal for the prevention of and reaction to physical harm. It has recently been hypothesized that “social pain,” as induced by social rejection or abandonment, may rely on comparable, phylogenetically old brain structures. As plausible as this theory may sound, scientific evidence for this idea is sparse. This study therefore attempts to link both types of pain directly. We studied patients with borderline personality disorder (BPD) because BPD is characterized by opposing alterations in physical and social pain; hyposensitivity to physical pain is associated with hypersensitivity to social pain, as indicated by an enhanced rejection sensitivity. Method Twenty unmedicated female BPD patients and 20 healthy participants (HC, matched for age and education) played a virtual ball-tossing game (cyberball), with the conditions for exclusion, inclusion, and a control condition with predefined game rules. Each cyberball block was followed by a temperature stimulus (with a subjective pain intensity of 60% in half the cases). The cerebral responses were measured by functional magnetic resonance imaging. The Adult Rejection Sensitivity Questionnaire was used to assess rejection sensitivity. Results Higher temperature heat stimuli had to be applied to BPD patients relative to HCs to reach a comparable subjective experience of painfulness in both groups, which suggested a general hyposensitivity to pain in BPD patients. Social exclusion led to a subjectively reported hypersensitivity to physical pain in both groups that was accompanied by an enhanced activation in the anterior insula and the thalamus. In BPD, physical pain processing after exclusion was additionally linked to enhanced posterior insula activation. After inclusion, BPD patients showed reduced amygdala activation during pain in comparison with HC. In BPD patients, higher rejection sensitivity was associated with lower activation
Hirsh, Jacob B; Quilty, Lena C; Bagby, R Michael; McMain, Shelley F
The working alliance between therapist and patient is an important component of effective interventions for borderline personality disorder (BPD). The current study examines whether client personality affects the development of the working alliance during the treatment of BPD, and whether this influences treatment effectiveness. Data was based on 87 patients with BPD who were participants in a randomized controlled trial comparing Dialectical Behavior Therapy (DBT) and general psychiatric management. Higher levels of trait Agreeableness were associated with steeper increases in working alliance throughout treatment, but only in the DBT condition. Increases in working alliance were in turn associated with better clinical outcomes. Mediation models revealed a significant indirect path from Agreeableness to better clinical outcomes, mediated through larger improvements in working alliance over time. These results highlight the role that patient personality can play during the therapeutic process, with a specific focus on the importance of Agreeableness for alliance development.
Bos, Elisabeth H.; van Wel, E. Bas; Appelo, Martin T.; Verbraak, Marc J. P. M.
Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for persons with borderline personality disorder (BPD) that is relatively easy to implement. We investigated the efficacy of a Dutch version of this treatment (VERS). Seventy-nine DSM-IV BPD patients were
Psychopathy is a personality disorder characterized by remorseless and impulsive antisocial behavior. Given the significant societal costs of the recidivistic criminal activity associated with the disorder, there is a pressing need for more effective treatment strategies, and hence, a better understanding of the psychobiological mechanisms underlying the disorder. The prefrontal cortex (PFC) is likely to play an important role in psychopathy. In particular, the ventromedial and anterior cingu...
Full Text Available Objective: This research was an attempt to predict the tendency of people having borderline personality traits to smoking, drinking alcohol, and taking psychoactive drugs based on emotional dysregulation and child abuse. Method: This study employed a correlation method which is categorized in descriptive category. A sample including 600 male and female bachelor students of Tabriz University was selected by cluster sampling. Then, high risk behaviors scale, Emotional dysregulation Scale, Child abuse scale, and borderline personality scale (STB were distributed among this group. Findings: Stepwise multiple regression analysis suggested that emotional dysregulation and child abuse significantly predicted varying degrees of smoking, drug, and alcohol usage. Conclusion: The research findings suggest the basic role of initial biological vulnerability in terms of emotional regulation (dysregulation and invalidating family environment (child abuse in the prediction of catching the disorder of borderline personality traits and producing high riskbehaviorssuch as alcohol drink and drug usage.
Christopher T. A. Gillen; Henriette Bergstrøm; Forth, Adelle E.
The current study is the first to investigate whether individual differences in personality are related to improved first impression accuracy when appraising psychopathy in female offenders from thin-slices of information. The study also investigated the types of errors laypeople make when forming these judgments. Sixty-seven undergraduates assessed 22 offenders on their level of psychopathy, violence, likability, and attractiveness. Psychopathy rating accuracy improved as rater extroversion-...
Mosquera, Dolores; Gonzalez, Anabel; Leeds, Andrew M
Persistent problems in emotional regulation and interpersonal relationships in borderline patients can be understood as developing from difficulties in early dyadic regulation with primary caregivers. Early attachment patterns are a relevant causal factor in the development of Borderline Personality Disorder (BPD). Links between attachment issues, early history of neglect, and traumatic experiences, and symptoms observed in patients with BPD as per the DSM-5 classification (American Psychiatric Association: Diagnostic and statistical manual of mental disorders: DSM-5 (Fifth ed.). Washington, D.C; (2013)) are described in this article, while delineating possible pathways from attachment disruptions to the specific symptomatology of these patients. The theory of structural dissociation of the personality (TSDP) provides an essential framework for understanding the processes that may lead from insecure early attachment to the development and maintenance of BPD symptoms. Dyadic parent-child interactions and subsequent modulation of emotion in the child and future adult are considered closely related, but other factors in the development of BPD, such as genetic predisposition and traumatic experiences, should also be considered in conceptualizing and organizing clinical approaches based on a view of BPD as a heterogeneous disorder.
Leppänen, V; Hakko, H; Sintonen, H; Lindeman, S
The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.
Full Text Available Background and Aim: Discourse-based interventions were studied less in speech therapy. This study aimed to investigate the effects of discourse-based intervention on language disabilities in school-aged children with borderline intelligence quotient (IQ.Methods: In an experimental study, 33 students at the age of 6-13 years with borderline intelligence quotient (17 students for intervention and 16 students for control group were selected with available sampling. The intervention lasted 14 sessions (every session: 45 minutes that focused on the structure and content of discourse. Personal narrative was elicited with explanation of the same topic (go to a trip for pre- and post-test.Results: Mean scores of intelligence quotient, age and education had no difference between the two groups. The intervention caused the increase of compound sentences (p=0.038, types of cohesive conjunctions (p=0.003, and related information (p=0.008 and decrease of ungrammatical sentences (p=0.031.Conclusion: Our findings indicate that participation in the intervention program has a clinically significant effect on the participants' abilities to produce personal narrative.
Beauchaine, Theodore P; Klein, Daniel N; Crowell, Sheila E; Derbidge, Christina; Gatzke-Kopp, Lisa
Although antisocial personality disorder (ASPD) is more common among males and borderline PD (BPD) is more common among females, some authors have suggested that the two disorders reflect multifinal outcomes of a single etiology. This assertion is based on several overlapping symptoms and features, including trait impulsivity, emotional lability, high rates of depression and suicide, and a high likelihood of childhood abuse and/or neglect. Furthermore, rates of ASPD are elevated in the first degree relatives of those with BPD, and concurrent comorbidity rates for the two disorders are high. In this article, we present a common model of antisocial and borderline personality development. We begin by reviewing issues and problems with diagnosing and studying PDs in children and adolescents. Next, we discuss dopaminergic and serotonergic mechanisms of trait impulsivity as predisposing vulnerabilities to ASPD and BPD. Finally, we extend shared risk models for ASPD and BPD by specifying genetic loci that may confer differential vulnerability to impulsive aggression and mood dysregulation among males and impulsive self-injury and mood dysregulation among females. Although the precise mechanisms of these sex-moderated genetic vulnerabilities remain poorly understood, they appear to interact with environmental risk factors including adverse rearing environments to potentiate the development of ASPD and BPD.
Myers, Wade C; Gooch, Erik; Meloy, J Reid
The case of Aileen Wuornos, executed in Florida for the serial killing of seven men, is studied to determine her degree of psychopathy and the presence or absence of sexuality or sexual sadism as a motivation or gratification for her crimes. The authors, one of whom evaluated the subject shortly before her death, determined that she evidenced a psychopathic personality (PCL-R score 32). She also met DSM-IV-TR criteria for Antisocial Personality Disorder and Borderline Personality Disorder. While her killings ostensibly were carried out during routine acts of prostitution, there was ambiguous evidence that her crimes were sexually motivated or gratifying. Her articulated motivation was robbery and elimination of the witness/victim. After carefully considering all available data, the authors concluded there was no convincing evidence of sexual sadism in either her personal history or her method of committing serial murder, and it remains unclear whether sexual gratification was to some degree a motivating factor in her commission of these offenses. The confluence of early childhood attachment disruptions, severe psychopathy, other personality disorder pathology, and a traumagenic abuse history likely contributed to her having serially murdered seven victims.
Colombo, María Cecilia; Hedderwick, Alejandro; Tauguinas, Natalia; Rodante, Demián
The evidence shows that borderline personality disorder (BPD) is the most frequently diagnosed personality disorder. However, the diagnostic criteria are very heterogeneous, suggesting that very different patients may be included within a single construct. Despite its severity, there are no standardized treatments for this group of patients. We find the same problem in the Acute Mental Health Services. The numerous proposals that have been put forward are unclear and have not reached a final consensus. According to Oldham's classification, BPD can be divided into the following subtypes: Affective, Impulsive, Aggressive, Empty and Dependent. In this paper, we propose a psychotherapeutic initial approach from the Dialectical Behavioral Therapy (DBT) perspective and an initial psychopharmacological approach for each subtype of BPD.
Annemiek van Dijke
Full Text Available Background: Although affect dysregulation is considered a core component of borderline personality disorder (BPD and somatoform disorders (SoD, remarkably little research has focused on the prevalence and nature of affect dysregulation in these disorders. Also, despite apparent similarities, little is known about how dysfunctional under- and overregulation of affect and positive and negative somatoform and psychoform dissociative experiences inter-relate. Prior studies suggest a clear relationship between early childhood psychological trauma and affect dysregulation, especially when the caretaker is emotionally, sexually, or physically abusing the child, but how these relate to under- and overregulation while differentiating for developmental epochs is not clear. Although an elevated risk of childhood trauma exposure or complex posttraumatic stress disorder (CPTSD symptoms has been reported in BPD and SoD, trauma histories, dysfunctional affect regulation, dissociation, PTSD, and CPTSD were never assessed in unison in BPD and/or SoD. Method: BPD and/or SoD diagnoses were confirmed or ruled out in 472 psychiatric inpatients using clinical interviews. Dysfunctional under- and overregulation of affect and somatoform and psychoform dissociation, childhood trauma-by-primary-caretaker (TPC, PTSD, and CPTSD were all measured using self reports. Results: No disorder-specific form of dysfunctional affect regulation was found. Although both BPD and SoD can involve affect dysregulation and dissociation, there is a wide range of intensity of dysfunctional regulation phenomena in patients with these diagnoses. Evidence was found for the existence of three qualitatively different forms of experiencing states: inhibitory experiencing states (overregulation of affect and negative psychoform dissociation most commonly found in SoD, excitatory experiencing states (underregulation of affect and positive psychoform dissociation most commonly found in BPD, and
Full Text Available OBJECTIVE: To describe the concept of mentalization, and its application in understanding the development of psychopathology in patients with borderline personality disorder; to give an account of the main features of mentalization-based treatment; to summarise the evidence supporting its effectiveness. DISCUSSION: Mentalization is a predominantly preconscious mental activity that enables the individual to understand him/herself and others in terms of subjective states and mental processes. Psychological trauma in childhood is associated with deficits in mentalization and with the development of borderline personality disorder. Mentalization-based treatment is a psychodynamically-oriented manualized psychotherapy for borderline personality disorder that aims to develop a therapeutic process in which the patient's capacity for mentalization becomes the focus of treatment. Randomized controlled trials have demonstrated the effectiveness of this treatment for patients with borderline personality disorder. CONCLUSIONS: The development of a psychodynamically-oriented therapeutic intervention that specifically targets the deficits involved in the psychopathology of borderline personality disorder is a crucial step in increasing the effectiveness of treatment. Mental health professionals should be adequately prepared to deliver effective interventions to their patients, such as mentalization-based treatment.OBJETIVO: Descrever o conceito de mentalização e sua aplicação no entendimento do desenvolvimento da psicopatologia em pacientes com transtorno de personalidade borderline; descrever as principais características da terapia de mentalização; sumarizar as evidências que demonstram sua efetividade. DISCUSSÃO: Mentalização é uma atividade mental predominantemente pré-consciente que capacita o indivíduo a compreender a si mesmo e aos outros em termos de estados subjetivos e processos mentais. Trauma psicológico na infância está associado
Relationship between emotion regulation and emotional intelligence in borderline personality disorder [Strategie regulacji emocji a inteligencja emocjonalna u pacjentów z zaburzeniem osobowości borderline
Aim. A typical trait of borderline personality disorder is emotional instability. The strategies that patients with BPD use to regulate their affects are not yet known. The purpose of presented research was an attempt to find the often used emotion regulation strategies, the eventual differences in value of emotional intelligence between BPD patients and healthy controls, and a relationship between emotion regulation and emotional intelligence in BPD. The work on FrAGe (an own self-descriptiv...
Lynam, Donald R.; Charnigo, Richard; Moffitt, Terrie E.; Raine, Adrian; Loeber, Rolf; Stouthamer-Loeber, Magda
The current diagnostic system suggests that personality disorder categories be applied to children and adolescents in rare circumstances due to expected changes in personality pathology across development. The present study examined the stability in personality pathology, specifically psychopathy, across childhood and adolescence. Using a short form of the Childhood Psychopathy Scale (CPS; Lynam, 1997) and mixed models incorporating fixed and random effects, we examined the reliability, individual stability, mean-level stability, and predictive utility of juvenile psychopathy as a function of age (i.e., from 7 years old to 17 years old) in over 1500 boys from the three cohorts of the Pittsburgh Youth Study. If adolescent development contributes to instability in personality pathology, large age-related fluctuations in reliability, stability, and predictive utility should be observed, particularly in the latter part of adolescence when normative changes are hypothesized to influence levels of psychopathy. Such fluctuations were not observed. In general, juvenile psychopathy could be reliably assessed beginning in childhood, was fairly stable across short and long intervals, showed little mean-level fluctuation, and predicted delinquency across adolescence. These results suggest that concerns about large changes in personality pathology across childhood and adolescence may be overstated. Implications and future directions are discussed. PMID:19825261
Pozza, Andrea; Giaquinta, Nicoletta; Dèttore, Davide
Pathological skin picking (SP) is a strongly impairing condition characterized by repetitive picking behaviors resulting in significant tissue damage and distress. Recent research suggested the presence of different subtypes of SP. No study has investigated which personality traits could be specifically associated with different subtypes. In a community sample (N=285, 71.20% females, mean age =34.98 years, standard deviation =15.91), this cross-sectional study investigated which personality traits and emotion regulation deficits could predict specific SP subtypes. Participants completed the Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS), Millon Clinical Multiaxial Inventory-III personality scales (MCMI-III), and Difficulties in Emotion Regulation Scale (DERS) questionnaires. Higher scores on the MCMI-III borderline (β=0.28, t=4.88, P<0.001), MCMI-III avoidant scale (β=0.18, t=2.59, P<0.01), and DERS difficulties engaging in goal-directed behavior (β=0.19, t=3.27, P<0.01) predicted higher scores on the MIDAS automatic scale. Higher scores on the MCMI-III borderline (β=0.30, t=5.23, P<0.001) and DERS difficulties engaging in goal-directed behavior (β=0.15, t=2.52, P<0.05) and DERS limited access to emotion regulation strategies (β=0.21, t=3.26, P<0.01) predicted higher scores on the MIDAS focused scale. Higher scores on the MCMI-III sadistic (β=0.19, t=3.30, P<0.001) and DERS difficulties engaging in goal-directed behavior (β=0.15, t=2.68, P<0.01) predicted higher scores on the MIDAS mixed scale. Implications for future research and treatment are discussed.
Matusevich, Daniel; Ruiz, Martín; Vairo, María C
The purpose of this paper is to go along the different senses and meanings that borderline diagnosis has had across time. On behalf of this, many original papers as well as textbooks and other works are analyzed, to define the way and significant points in the discovery or construction of this critical pathology, that even today still divides the opinions in health world community. From Prichard, to Stern, Deutsch, Grinker and Knight, till Kernberg, Gunderson, Linehan and Fonagy we try to put clear the most important contributions of each author.
Powers, Abigail D; Gleason, Marci E J; Oltmanns, Thomas F
Individuals with borderline personality disorder (BPD) often experience stressful life events at a higher frequency than those without BPD. It is less clear what specific types of events are involved in this effect, and it has not been determined whether some features of BPD are more important than others in accounting for this effect. The latter issue is important in light of the heterogeneous nature of this diagnostic construct. These issues were examined in a large, representative community sample of men and women, ages 55-64. Ten Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR, Washington, DC, American Psychiatric Association, 2000) personality disorders were assessed at baseline using the Structured Interview for DSM-IV Personality: SIDP-IV (B. Pfohl, N. Blum, & M. Zimmerman, 1997, Washington, DC, American Psychiatric Press). Life events were measured at three sequential assessments following baseline at 6-month (N = 1,294), 12-month (N = 1,070), and 18-month (N = 837) follow-ups. Stressful life events were identified using a self-report questionnaire (LTE-Q; List of Threatening Experiences Questionnaire: A subset of prescribed life events with considerable long-term contextual threat by T. Brugha, C. Bebbington, P. Tennant, and J. Hurry, 1985, Psychological Medicine, Vol. 15, pp. 189-194.) followed by a telephone interview. Only borderline personality pathology was related to an increase in the frequency of interpersonal stressful life events. Three specific symptoms of BPD were largely responsible for this connection: unstable interpersonal relationships, impulsivity, and chronic feelings of emptiness (negative association). Symptoms of avoidant and schizoid personality disorders were associated with a reduced number of stressful life events that are considered to be outside a person's control (e.g., serious illness, injury, or death of a loved one). None of the personality disorders predicted an increase in the number of
Lynam, Donald R.; Caspi, Avshalom; Moffitt, Terrie E.; Raine, Adrian; Loeber, Rolf; Stouthamer-Loeber, Magda
The present study examines the relation between psychopathy and the Big Five dimensions of personality in two samples of adolescents. Specifically, the study tests the hypothesis that the aspect of psychopathy representing selfishness, callousness, and interpersonal manipulation (Factor 1) is most strongly associated with low Agreeableness,…
Cima, M.; Oorsouw, K. van
The objective of this study was to investigate whether levels of psychopathy predicted claims of crime-related amnesia. Different characteristics of psychopathy were based on the factor structure of the self-report questionnaire Psychopathic Personality Inventory (PPI). Crime-related amnesia claims
The severity of Internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students.
Dalbudak, Ercan; Evren, Cuneyt; Aldemir, Secil; Evren, Bilge
The aim of this study was to investigate the relationship of Internet addiction (IA) risk with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. A total of 271 Turkish university students participated in this study. The students were assessed through the Internet Addiction Scale (IAS), the Borderline Personality Inventory (BPI), the Dissociative Experiences Scale (DES), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The rates of students were 19.9% (n=54) in the high IA risk group, 38.7% (n=105) in the mild IA risk group and 41.3% (n=112) in the group without IA risk. Correlation analyses revealed that the severity of IA risk was related with BPI, DES, emotional abuse, CTQ-28, depression and anxiety scores. Univariate covariance analysis (ANCOVA) indicated that the severity of borderline personality features, emotional abuse, depression and anxiety symptoms were the predictors of IAS score, while gender had no effect on IAS score. Among childhood trauma types, emotional abuse seems to be the main predictor of IA risk severity. Borderline personality features predicted the severity of IA risk together with emotional abuse, depression and anxiety symptoms among Turkish university students.
Stepp, Stephanie D.; Burke, Jeffrey D.; Hipwell, Alison E.; Loeber, Rolf
Little empirical evidence exists regarding the developmental links between childhood psychopathology and borderline personality disorder (BPD) in adolescence. The current study addresses this gap by examining symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) as potential precursors. ADHD and BPD…
Wingenfeld, Katja; Schaffrath, Camille; Rullkoetter, Nina; Mensebach, Christoph; Schlosser, Nicole; Beblo, Thomas; Driessen, Martin; Meyer, Bjorn
Posttraumatic stress disorder (PTSD) is an important possible outcome of exposure to traumatic events that occur in childhood. However, early traumatic experiences are also an important risk factor for several other mental disorders, such as borderline personality disorder and major depressive disorder. Furthermore, chronic stress, including daily…
Bruton, Wendy S.
As the demand for community mental health services grows, more and more counselors-in-training are being asked to face the challenge of working with high needs clients, including clients with Borderline Personality Disorder (BPD). Counselors-in-training are entering therapeutic relationships with high-risk clients without training specifically…
D. Bales; N. van Beek; M. Smits; S. Willemsen; J.J.V. Busschbach; R. Verheul; H. Andrea
Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As
Pizzarello, Scott; Taylor, Jeanette
Objective: To determine if the substance use patterns of one's close friends and romantic partners would be a significant contributor to the co-occurrence of borderline personality disorder (BPD) features and drug use problems above and beyond impulsivity and negative emotionality. Participants: Participants were 2,202 undergraduates who attended…
D.L. Bales (Dawn); E.R. van Beek (Ermond); M. Smits (Maaike); S.P. Willemsen (Sten); J.J. van Busschbach (Jan); R. Verheul (Roel); H. Andrea (Helene)
textabstractPsychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingd
E. Fassbinder; A. Hauer; A. Schaich; U. Schweiger; G.A. Jacob; A. Arntz
Borderline personality disorder (BPD) is a severe, highly prevalent mental disorder. Effective psychological treatments for BPD are available. However, most patients do not receive evidence-based treatments partly because of high treatment delivery costs and lack of specialized therapists. By integr
Riemann, G.; Weisscher, N.; Goossens, P.J.J.; Draijer, N.; Apenhorst-Hol, M.; Kupka, R.W.
BACKGROUND: Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available sho
Dijk, F.E. van; Lappenschaar, M.; Kan, C.C.; Verkes, R.J.; Buitelaar, J.K.
OBJECTIVE: There is substantial symptomatic overlap between attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults, but the nature of the relationship between these disorders needs further clarification. The role of temperament and character traits in the
周敏; 骆加文; 谢斌
目的 探讨边缘型人格障碍的临床特征及与其他相关人格障碍的表现异同.方法 对住院诊断为人格障碍的49例病史资料进行调查登记和再诊断.然后对各型人格障碍的临床特点进行比较分析.结果 边缘型人格障碍的临床表现与其他类型有相似重叠之处但又不完全相同.结论 边缘型人格障碍可能是一个亚型,与冲动型人格之间有较大联系.%Objective To compare the clinical characteristics of borderline personality disorder with other related personality disorders.Methods A total of 49 files of inpatients with personality disorder diagnosed according to CCMD -2- R or CCMD -3 were retrospectively reviewed and rediagnosed according to DSM -Ⅳ.Clinical characteristics were compared among the rediagnosed subgroups.Results The clinical profiles of borderline personality disorder had much overlaps as well as some differences with other personality disorders.Conclusion Borderline personality disorder might be a independent subtype of personality disorder.It has close relationship with the impulsive personality disorder.
Kingdon, David G; Ashcroft, Katie; Bhandari, Bharathi; Gleeson, Stefan; Warikoo, Nishchint; Symons, Matthew; Taylor, Lisa; Lucas, Eleanor; Mahendra, Ravi; Ghosh, Soumya; Mason, Anthony; Badrakalimuthu, Raja; Hepworth, Claire; Read, John; Mehta, Raj
This study investigated similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma in schizophrenia and borderline personality disorder (BPD). Patients with clinical diagnoses of schizophrenia or BPD were interviewed using the Structured Clinical Interviews for DSM-IV. Axes 1 and 2 and auditory hallucinations, paranoia, and childhood trauma were assessed. A total of 111 patients participated; 59 met criteria for schizophrenia, 33 for BPD, and 19 for both. The groups were similar in their experiences of voices, including the perceived location of them, but they differed in frequency of paranoid delusions. Those with a diagnosis of BPD, including those with schizophrenia comorbidity, reported more childhood trauma, especially emotional abuse. BPD and schizophrenia frequently coexist, and this comorbidity has implications for diagnostic classification and treatment. Levels of reported childhood trauma are especially high in those with a BPD diagnosis, whether they have schizophrenia or not, and this requires assessment and appropriate management.
McMain, Shelley; Links, Paul S; Guimond, Tim; Wnuk, Susan; Eynan, Rahel; Bergmans, Yvonne; Warwar, Serine
This exploratory study examined specific emotion processes and cognitive problem-solving processes in individuals with borderline personality disorder (BPD), and assessed the relationship of these changes to treatment outcome. Emotion and cognitive problem-solving processes were assessed using the Toronto Alexithymia Scale, the Linguistic Inquiry Word Count, the Derogatis Affect Balance Scale, and the Problem Solving Inventory. Participants who showed greater improvements in affect balance, problem solving, and the ability to identify and describe emotions showed greater improvements on treatment outcome, with affect balance remaining statistically significant under the most conservative conditions. The results provide preliminary evidence to support the theory that specific improvements in emotion and cognitive processes are associated with positive treatment outcomes (symptom distress, interpersonal functioning) in BPD. The implications for treatment are discussed.
Brown, Whitney C; Tragesser, Sarah L; Tomko, Rachel L; Mehl, Matthias R; Trull, Timothy J
We used the Electronically Activated Recorder to observe 31 individuals with either borderline personality disorder (BPD; n = 20) or a history of a depressive disorder (n = 11). The Electronically Activated Recorder yielded approximately forty-seven 50-second sound clips per day for 3 consecutive days. Recordings were coded for expressed positive affect (PA) and negative affect (NA), and coder ratings were compared to participants' reports about their PA and NA during interpersonal events. BPD participants did not differ from participants with depressive disorder in terms of their recalled levels of NA or PA across different types of interpersonal events. However, significant discrepancies between recalled and observed levels of NA and PA were found for BPD participants for all types of interpersonal events. These findings may reflect limitations in the ability of those with BPD to recall their emotional intensity during interpersonal events and may also provide some evidence for emotional invalidation experienced by those with BPD.
Jacob, Gitta A; Gabriel, Susanne; Roepke, Stefan; Stoffers, Jutta M; Lieb, Klaus; Lammers, Claas-Hinrich
Psychotherapeutic treatments of borderline personality disorder (BPD) often focus on severe behavioral problems. Until now, few techniques have been developed to specifically address low self-esteem in BPD. We developed a 6-session psychoeducative group therapy module to treat low self-esteem in BPD patients. After developing and piloting the therapy module, a controlled outpatient pilot study was performed. Nineteen female BPD patients participated in the group module after discharge from an inpatient DBT program. Twenty-four female BPD patients served as controls. Outcome was assessed by different self-esteem measures. Results showed a greater improvement in self-esteem in the intervention group. The findings suggest that the therapy module is an effective adjunctive treatment in increasing self-esteem in BPD.
Dixon-Gordon, Katherine L; Gratz, Kim L; Breetz, Alisa; Tull, Matthew
This study sought to build upon existing research on interpersonal sensitivity in borderline personality disorder (BPD) by examining whether emotion dysregulation mediates the relationship between BPD and cognitive and emotional responses to social rejection. Participants with (n = 53) and without (n = 34) BPD reported on levels of negative affect and threat to four social needs (perceived control, belonging, selfesteem, and meaningful existence) in response to a laboratory-based social ostracism task (Cyberball). Results revealed heightened interpersonal (rejection) sensitivity among BPD (vs. non-BPD) participants, as evidenced by heightened threat to all social needs and nonspecific distress (although not overall negative affect) in response to the task. Furthermore, both overall emotion dysregulation and the specific dimensions involving emotion modulation strategies, emotional clarity, and the control of behaviors when distressed mediated the relationship between BPD status and several cognitive (threats to meaningful existence, belonging, and self-esteem) and emotional (nonspecific distress) responses to the task.
ZHONG Jie; LEUNG Freedom
@@ Borderline personality disorder (BPD) is a serious Bpersonality disorder characterized by a pervasive pattern of disturbances in mood regulation, impulse control, self-image and interpersonal relationships.1 In the United States, the prevalence of BPD has been estimated at 1%-2% of the general population, 10% of psychiatric outpatients, and 20% of inpatients.2,3 According to the 4th text revision of diagnostic and statistical manual of mental disorders (DSM-Ⅳ-TR),1 about 75% of BPD patients are women. The BPD diagnosis has been associated with heightened risk (8.5% to 10.0% among BPD patients) for completed suicide, a rate almost 50times higher than in the general population.4
Full Text Available Personality disorders (PDs are highly prevalent in patients receiving psychiatric services, and are associated with significant personal and social costs. Over the past two decades, an increasing number of treatment studies have documented the effectiveness of treatment for patients with PDs, especially when it comes to reduction of symptom distress, risk taking behavior, self-harm, or suicide attempts. However, less is known about the more complex aims of improving the personality structure itself, such as identity- and interpersonal disturbances. Emotional dysfunction is closely associated with PD pathology. The present study investigated changes in affect consciousness (AC in patients with avoidant or borderline PD, and how these changes were associated with clinical status after 3 years of follow-up. The study included 52 individuals; 79 percent were females, and mean age was 30 years. The evaluations included the Affect Consciousness Interview, Symptom Checklist-90-R, Circumplex of Interpersonal Problems, the Index of Self-Esteem, and three domains (Identity Integration, Relational Capacities, and Self-Control of the Severity Indices of Personality Problems (SIPP-118. There was a significant increase in the Global AC and AC scores for most of the specific affects from baseline to follow-up. As the present study did not include a control group, it cannot be concluded that changes in AC are effects of psychotherapy, and the possibility of age-related maturation processes cannot be excluded. The change in Global AC contributed significantly to explained variance in the follow-up levels of Circumplex of Interpersonal Problems, and the two SIPP-118 domains Relational Capacities and Identity Integration. Improved AC was not associated with change in the Self-Control domain or the Global Severity Index of Symptom Checklist-90-R. The results suggest that AC may be altered for patients with borderline and avoidant PDs, and this is the first study to
Daniel Brian Krupp; Sewall, Lindsay A.; Lalumière, Martin L.; Craig eSheriff; Grant eHarris
In a recent study, we found a negative association between psychopathy and violence against genetic relatives. We interpreted this result as a form of nepotism and argued that it failed to support the hypothesis that psychopathy is a mental disorder, suggesting instead that it supports the hypothesis that psychopathy is an evolved life history strategy. This interpretation and subsequent arguments have been challenged in a number of ways. Here, we identify several misunderstandings regarding ...
Leistedt, S J-J; Braun, S; Coumans, N; Linkowski, P
Although psychopathy has traditionally been cited as a disorder of personality, confusion arises as the term is used interchangeably with the terms antisocial personality disorder of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV TR) or dissocial personality disorder, both of which are largely behaviorally based. This paper aims to provide a clinical and scientific overview of the literature on the topic of psychopathy, which examines this conundrum. This article begins with a wee bit of history about Hervey Cleckley's work, The Mask of Sanity, and then presents the definitions and nosography of psychopathy, focusing on the distinction between the antisocial psychopath and the successful psychopath. The discussion will then lead on the epidemiological aspects and diagnosis, especially psychometric and measurement tools used to assess psychopathy in the individual: Hare's Psychopathy Checklist-Revised (PCL-R), as this is the most frequently used and validated measure of psychopathy. The second section of the article reviews several studies dealing with structural and functional neuroimaging in psychopaths. The final part of this overview considers the treatment and interventions that are available to psychopathic offenders and the implications for future research, especially in terms of prevention. This review demonstrates that studies and further research are still required in psychopathy, particularly using functional neuroimaging techniques, as fMRI and magnetoencephalography, that can describe the functional neuroanatomy of human emotion. Today, cognitive and social neurosciences constitute one of the most promising way to study psychopathy.
Fossati, Andrea; Borroni, Serena; Feeney, Judith; Maffei, Cesare
The aims of this study were to assess whether Borderline Personality Disorder (BPD) features could be predicted by Big Five traits, impulsivity, identity orientation, and adult attachment patterns in a sample of 1,192 adult nonclinical participants, and to evaluate the consistency of these regression models across four age groups (50 years, respectively). In the full sample, measures of neuroticism (N), impulsivity, and anxious insecure attachment were substantial predictors of BPD features (adjusted R(2) = .38, p Attachment scales were significant predictors of BPD features across all age groups, but different scales were relevant in different age groups. Our results suggest that in nonclinical populations, BPD may represent a complex constellation of personality traits and disturbed attachment patterns.
Kopala-Sibley, Daniel C; Zuroff, David C; Russell, Jennifer J; Moskowitz, D S; Paris, Joel
This study examined whether the personality traits of self-criticism and dependency respectively moderated the effects of perceived inferiority and emotional insecurity on negative affect during interpersonal interactions in individuals with borderline personality disorder (BPD). A sample of 38 patients with BPD and matched community comparison participants completed event-contingent record forms after each significant interaction for a 20-day period. Multilevel models showed that, controlling for baseline levels of depressive symptoms and neuroticism, as well as lagged negative affect, event-level elevations in perceived inferiority and emotional insecurity were related to more negative affect in both groups. Event-level perceived inferiority was more strongly associated with negative affect in patients with BPD who reported higher levels of self-criticism, while event-level perceived emotional insecurity was more strongly associated with negative affect in patients with BPD who reported higher levels of dependency. No significant interactions emerged for the comparison group. These findings further our understanding of differences among patients with BPD and support the application of personality-vulnerability or diathesis-stress models in predicting negative affect in BPD. Results have implications for the design of therapies for patients with BPD.
Full Text Available Abstract Background In the development of borderline personality disorder (BPD both genetic and environmental factors have important roles. The characteristic affective disturbance and impulsive aggression are linked to imbalances in the central serotonin system, and most of the genetic association studies focused on serotonergic candidate genes. However, the efficacy of dopamine D2 receptor (DRD2 blocking antipsychotic drugs in BPD treatment also suggests involvement of the dopamine system in the neurobiology of BPD. Methods In the present study we tested the dopamine dysfunction hypothesis of impulsive self- and other-damaging behaviors: borderline and antisocial traits were assessed by Structured Clinical Interview for Diagnosis (SCID for DSM-IV in a community-based US sample of 99 young adults from low-to-moderate income families. For the BPD trait analyses a second, independent group was used consisting of 136 Hungarian patients with bipolar or major depressive disorder filling out self-report SCID-II Screen questionnaire. In the genetic association analyses the previously indicated polymorphisms of the catechol-O-methyl-transferase (COMT Val158Met and dopamine transporter (DAT1 40 bp VNTR were studied. In addition, candidate polymorphisms of the DRD2 and DRD4 dopamine receptor genes were selected from the impulsive behavior literature. Results The DRD2 TaqI B1-allele and A1-allele were associated with borderline traits in the young adult sample (p = 0.001, and p = 0.005, respectively. Also, the DRD4 -616 CC genotype appeared as a risk factor (p = 0.02. With severity of abuse accounted for in the model, genetic effects of the DRD2 and DRD4 polymorphisms were still significant (DRD2 TaqIB: p = 0.001, DRD2 TaqIA: p = 0.008, DRD4 -616 C/G: p = 0.002. Only the DRD4 promoter finding was replicated in the independent sample of psychiatric inpatients (p = 0.007. No association was found with the COMT and DAT1 polymorphisms. Conclusions Our results
Blair, R. J. R.; Peschardt, K. S.; Budhani, S.; Mitchell, D. G. V.; Pine, D. S.
The current review focuses on the construct of psychopathy, conceptualized as a clinical entity that is fundamentally distinct from a heterogeneous collection of syndromes encompassed by the term "conduct disorder". We will provide an account of the development of psychopathy at multiple levels: ultimate causal (the genetic or social primary…
Critchfield, Kenneth L; Levy, Kenneth N; Clarkin, John F; Kernberg, Otto F
Attachment theory provides a framework for understanding and predicting critical aspects of aggression in the personality disorders. An association between borderline personality disorder (BPD) and insecure forms of adult attachment marked by high relationship anxiety has been repeatedly observed in the empirical literature. Aggression also has been linked to insecure attachment. The present study extends previous work by exploring the degree to which the underlying attachment dimensions of relationship anxiety and avoidance are associated in BPD with the following forms of hostility: (a) direct aggression (verbal or physical) initiated towards others, (b) expectation/perception of aggression from others (including "reactive" counteraggression when/if provoked), (c) aggression directed towards the self in the form of suicidality or parasuicidality, and (d) affective experience of irritability or anger. The issue was studied in a sample of 92 patients diagnosed with BPD. Results show significant association between more fearful forms of attachment (simultaneous presence of relationship anxiety and avoidance) and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated only with relational avoidance while anger and irritability were associated only with relational anxiety. Implications for understanding relational aspects of BPD aggression in research and clinical work are discussed.
Full Text Available Aim. The aim of the researches was to inspect the relation between borderline personality and Machiavellianism as well as the tendency to apply various manipulation tactics in everyday life and in therapy.Method. The test used an original/ authors’ survey for testing the tendency to employ manipulation tactics as well as a MACH-IV questionnaire (Christie, Geis, 1970 for measuring Machiavellianism. The studied group included 30 patients with diagnosed BPD, 37 therapists and 30 persons in the control group.Results. No differences were noted in the general indicator of Machiavellianism; however, the patients scored lower on the Tactics scale than people from the control group. Patients preferred employing the tactics of taking offense, lying and begging in everyday life. Compared to people from the control group, patients presented a larger tendency to employ tactics of begging, threatening and threatening to break off a close relationship, and a lower tendency to employ seduction. According to therapists, during the therapy patients most often resorted to lying and arousing guilt. Therapists assessed the patients’ tendency to employ manipulation tactics higher than the patients themselves.
Stein, D J; Hollander, E; DeCaria, C M; Simeon, D; Cohen, L; Aronowitz, B
We have previously found that a subgroup of patients with impulsive personality disorders respond to m-chlorophenylpiperazine (m-CPP) administration with a distinctive spacy/high behavioral reaction and with increased cortisol responses. In this report we analyzed the relationship between behavioral and neuroendocrine responses to m-CPP in an enlarged sample of patients with borderline personality disorder (BPD). We also assessed the association of behavioral and neuroendocrine responses with clinical symptoms and with m-CPP blood levels. We found that in BPD patients the presence of a spacy/high behavioral response was significantly associated with increased prolactin and cortisol responses to m-CPP. In BPD patients increased m-CPP levels were significantly associated with neuroendocrine hypersensitivity and with a spacy/high behavioral response, while in controls increased m-CPP levels were not significantly associated with neuroendocrine hypersensitivity but were significantly associated with dysphoric behavioral responses. Taken together with previous work on m-CPP in obsessive-compulsive disorder, these results are partially consistent with the hypothesis that compulsive and impulsive symptoms fall at opposite ends of a phenomenologic and neurobiologic spectrum.
Burgmer, M; Jessen, F; Freyberger, H J
The present study addresses the question whether the polythetic approach of ICD-10 and DSM-IV is useful in clinical practice for the diagnosis 'Borderline' personality disorder (BPD). A questionnaire containing all individual criteria for the 9 personality disorders and the schizotypal disorder used by the ICD-10, completed by the DSM-IV criteria for the BPD not covered by the ICD-10, was developed. Eight hundred therapists were asked to mark the importance of every single criterion for forming the diagnosis or for ruling out BPD. Our data analysis of the received questionnaires performed a rankscore based on an altered calculation of the mean value. The criteria which described the patients' instability in relationship and mood, and identity disturbances were seen as the most important features for the diagnosis of BPD. The criterion of cognitive disturbances, newly introduced in DSM-IV, was not felt to be a major clinical feature. In conclusion, our study reflects the results of other authors in the sense that a single criterion cannot be considered pathognomonic for BPD, but has greater importance and a higher priority in establishing the diagnosis BPD. This should be taken into account to reconsider the polythetic concept in favor of a hierarchical approach with core criteria.
Macfie, Jenny; Swan, Scott A; Fitzpatrick, Katie L; Watkins, Christopher D; Rivas, Elaine M
Borderline personality disorder (BPD) involves disruptions in attachment, self, and self-regulation, domains conceptually similar to developmental tasks of early childhood. Because offspring of mothers with BPD are at elevated risk of developing BPD themselves (White, Gunderson, Zanarini, & Hudson, 2003), studying them may inform precursors to BPD. We sampled 31 children age 4-7 whose mothers have BPD and 31 normative comparisons. We examined relationships between mothers' Adult Attachment Interview (AAI) representations (George, Kaplan, & Main, 1984), mothers' observed parenting, and children's narrative representations. Replicating previous studies, mothers with BPD were more likely to be classified as preoccupied and unresolved on the AAI. In a larger sample, which included the current one, we also replicated two underlying AAI dimensions found in normative samples (Roisman, Fraley, & Belsky, 2007; Whipple, Bernier, & Mageau, 2011). Controlling for current mood, anxiety, and other personality disorders, mothers with BPD were significantly higher than were comparisons on the preoccupied/unresolved, but not the dismissive, dimension. Children's narrative representations relevant to disruptions in attachment (fear of abandonment and role reversal), self (incongruent child and self/fantasy confusion), and self-regulation (destruction of objects) were significantly correlated with the preoccupied/unresolved, but not the dismissive, dimension. Furthermore, mothers' parenting significantly mediated the relationship between the preoccupied/unresolved dimension and their children's narrative representations of fear of abandonment.
Perugi, Giulio; Fornaro, Michele; Akiskal, Hagop S
The constructs of atypical depression, bipolar II disorder and borderline personality disorder (BPD) overlap. We explored the relationships between these constructs and their temperamental underpinnings. We examined 107 consecutive patients who met DSM-IV criteria for major depressive episode with atypical features. Those who also met the DSM-IV criteria for BPD (BPD+), compared with those who did not (BPD-), had a significantly higher lifetime comorbidity for body dysmorphic disorder, bulimia nervosa, narcissistic, dependent and avoidant personality disorders, and cyclothymia. BPD+ also scored higher on the Atypical Depression Diagnostic Scale items of mood reactivity, interpersonal sensitivity, functional impairment, avoidance of relationships, other rejection avoidance, and on the Hopkins Symptoms Check List obsessive-compulsive, interpersonal sensitivity, anxiety, anger-hostility, paranoid ideation and psychoticism factors. Logistic regression revealed that cyclothymic temperament accounted for much of the relationship between atypical depression and BPD, predicting 6 of 9 of the defining DSM-IV attributes of the latter. Trait mood lability (among BPD patients) and interpersonal sensitivity (among atypical depressive patients) appear to be related as part of an underlying cyclothymic temperamental matrix.
Vicente Garrido Genovés (España
Full Text Available En la actualidad está bien establecido que ciertos trastornos mentales incrementan el riesgo de realizar comportamientos violentos. En particular esto es cierto para el abuso de sustancias y el grupo B de los trastornos de personalidad del DSM-IV (Garrido, 2003. También tendríamos que incluir en esta relación —aunque en menor medida— los trastornos incluidos en el espectro de la esquizofrenia, en particular los síntomas paranoides de amenaza y de control, y en general el estilo cognitivo de personalidad paranoide (Nestor, 2002. No obstante, yo me referiré tan sólo a la relación existente entre el mencionado grupo B y el abuso de sustancias y su vinculación con el delito y la violencia. Más en concreto, atenderé especialmente, dentro de ese grupo B, al trastorno antisocial de la personalidad y a la psicopatía (aunque no son términos todo intercambiables, como luego veremos y su capacidad para predecir tales comportamientos desviados de violencia y conducta antisocial. Currently it is well established that certain mental disorders increase the risk for violent behaviour. This is in particular true for the Group B of the DSM-IV (2003 Garrido personality disorders and substance abuse. Would also have to include disorders included in the spectrum of schizophrenia, paranoid and control symptoms in particular, and in general the cognitive style of personality in this relationship -although in smaller measure- paranoid (Nestor, 2002. I refer only to the relationship between the Group (b and substance abuse and its link with crime and violence. More specifically, within that group B, the antisocial personality disorder and psychopathy (although they are not all interchangeable terms, as we shall see and its ability to predict such behavior diverted from violence and antisocial behaviour.
Full Text Available Abstract Background Borderline Personality Disorder (BPD is a common mental disorder associated with raised mortality, morbidity and substantial economic costs. Although complex psychological interventions have been shown to be useful in the treatment of BPD, such treatments are expensive to deliver and therefore have limited availability and questionable cost-effectiveness. Less complex interventions are required for the management of BPD. A Joint Crisis Plan (JCP is a record containing a service user's treatment preferences for the management of future crises and is created by the service user with the help of their treating mental health team. These plans have been shown to to be an effective way of reducing compulsory treatment in people with psychosis. However, to date they have not been used with individuals with BPD. This exploratory trial will examine whether use of a JCP is an effective and cost-effective intervention for people with BPD for reducing self-harm. Methods/Design In this single blind exploratory randomized controlled trial, a total of 120 participants (age >18 years with a primary diagnosis of DSM-IV borderline personality disorder will be recruited from community mental health teams and, after completing a baseline assessment, will be assigned to one of two conditions: (1 a Joint Crisis Plan, or (2 treatment as usual. Those allocated to the JCP condition will take part in a facilitated meeting, the purpose of which will be to agree the contents of the plan. Following the meeting, a typed version of the JCP will be sent to the patient and to any other individuals specified by the participant. All participants will be followed-up at 6 months. The primary outcome measures are: any self-harm event, time to first episode of self-harm and number of self-harm events over the follow-up period. Secondary outcome measures are length of time from contemplation to act of self-harm, help-seeking behaviour after self-harm, cost, working
Vries, de R.E.; Kampen, van D.
This study describes and tests two models of personality: the HEXACO model of personality, which is derived from the lexical tradition and which is rooted in “normal” psychology, and the 5DPT model of personality, which is derived from a theoretical approach and which is rooted in clinical psycholog
Harned, Melanie S; Jackson, Safia C; Comtois, Katherine A; Linehan, Marsha M
This study examined the efficacy of dialectical behavior therapy (DBT) in reducing behaviors commonly used as exclusion criteria for posttraumatic stress disorder (PTSD) treatment. The sample included 51 suicidal and/or self-injuring women with borderline personality disorder (BPD), 26 (51%) of whom met criteria for PTSD. BPD clients with and without PTSD were equally likely to eliminate the exclusionary behaviors during 1 year of DBT. By posttreatment, 50-68% of the BPD clients with PTSD would have been suitable candidates for PTSD treatment. Borderline personality disorder clients with PTSD who began treatment with a greater number of recent suicide attempts and more severe PTSD were significantly less likely to become eligible for PTSD treatment.
Nadort, M.; Arntz, A.; Smit, J.H.; Giesen-Bloo, J.; Eikelenboom, M.; Spinhoven, P.; Asselt, T. van; Wensing, M.J.P.; Dyck, R. van
BACKGROUND: Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. It
Nadort, M.; Arntz, A.; Smit, J.H.; Giesen-Bloo, J.; Eikelenboom, M.J.; Spinhoven, P.; Asselt, van T.; Wensing, M.; Dyck, van R.
ABSTRACT: BACKGROUND: Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality dis
Beeney, Joseph E; Hallquist, Michael N; Ellison, William D; Levy, Kenneth N
Individuals with borderline personality disorder (BPD) display an impoverished sense of self and representations of self and others that shift between positive and negative poles. However, little research has investigated the nature of representational disturbance in BPD. The present study takes a multimodal approach. A card sort task was used to investigate complexity, integration, and valence of self-representation in BPD. Impairment in maintenance of self and other representations was assessed using a personality representational maintenance task. Finally, functional MRI (fMRI) was used to assess whether individuals with BPD show neural abnormalities related specifically to the self and what brain areas may be related to poor representational maintenance. Individuals with BPD sorted self-aspects suggesting more complexity of self-representation, but also less integration and more negative valence overall. On the representational maintenance task, individuals with BPD showed less consistency in their representations of self and others over the 3-hr period, but only for abstract, personality-based representations. Performance on this measure mediated between-groups brain activation in several areas supporting social cognition. We found no evidence for social-cognitive disturbance specific to the self. Additionally, the BPD group showed main effects, insensitive to condition, of hyperactivation in the medial prefrontal cortex, temporal parietal junction, several regions of the frontal pole, the precuneus and middle temporal gyrus, all areas crucial social cognition. In contrast, controls evidenced greater activation in visual, sensory, motor, and mirror neuron regions. These findings are discussed in relation to research regarding hypermentalization and the overlap between self- and other-disturbance.
Sharp, Carla; Mosko, Orion; Chang, Bonny; Ha, Carolyn
The Borderline Personality Disorder Features Scale for Children (BPFSC) is currently the only dimensional measure specifically developed to assess borderline features in children and adolescents. Few studies have investigated this measure for its concurrent validity and concordance between youth self-report and parent-report versions. To this end, the current study had two aims: (1) to investigate the cross-informant concordance (youth self-report vs. parent-report) of the BPFSC; and (2) to examine the concurrent validity of the BPFSC by showing that youth scoring high on the BPFSC also show poor clinical and psychosocial functioning, as measured by a standard Axis I scale. A community sample (N = 171) of boys between the ages of 8 and 18 completed the BPFSC and a self-report measure of Axis I psychopathology. Parents completed a newly developed parent-report version of the BPFSC (BPFSP) and a standard measure of Axis I psychopathology to index clinical and psychosocial functioning. Findings confirmed expectations. Modest concordance between parent- and self-report ratings were found. In addition, youth with borderline features showed poorer clinical and psychosocial functioning in all domains, especially where externalizing problems were concerned. Concurrent validity and modest parent-child concordance were demonstrated for the BPFSC. The BPFSC and BPFSP show promise as dimensional measures to assess borderline features in boys. However, a criterion validity study is needed before the measure can be used.
Full Text Available Background The aim of this research is to determine the level of emotion regulation, studied through the method of variable action orientation vs. state and its relationship with depressiveness and dimension of the reasons for living and self-harming behaviour of patients with borderline personality disorder. Participants and procedure The research studied 61 patients diagnosed with an emotionally unstable personality of borderline type. The research used the Polish adaptation of tests to measure the action vs. state orientation (SSI-K, the self-harming behaviour (SHI, depression (BDI and the reasons for living vs. suicidal tendency (RFL-I. Results In people with borderline personality disorder, the level of emotion regulation (action vs. state orientation, reasons for living and depression are predictors of self-harming behaviour. The experience of a depressive episode or lack thereof does not have a relationship with the increase of self-harming. Analysis of the interaction between variables showed that the reasons for living and the action orientation after failure are related to the reduction of self-harming behaviour in all subjects. In depressed people, state orientation is associated with an increase in the action orientation with decreased self-destructive behaviours. Conclusions High levels of reasons for living in interaction with the action orientation have a negative relationship with the self-harming behaviour of patients diagnosed with borderline personality disorder. Among those subjects, depressive patients, a statistically lower level of self-harm is related to the action orientation. These results suggest that therapeutic treatment is important to activate both reasons for living as well as action orientation as effective dimensions in preventing self-harming.
Full Text Available Rolf Wynn,1,2 Marita H Høiseth,1 Gunn Pettersen,31Department of Forensic Psychiatry, Division of Addiction and Specialized Psychiatric Services, University Hospital of North Norway, Tromsø, Norway; 2Telemedicine Research Group, Department of Clinical Medicine, 3Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, NorwayAbstract: Prior research on psychopathy has primarily focused on the problem in men. Only a few studies have examined whether psychopathy even exists in women, and if so, how the disorder manifests itself in them. This paper presents a narrative review of the literature on gender and psychopathy. We briefly discuss why this is an important topic for women and we discuss its causes. The concept of psychopathy is defined and related to the diagnostic systems. The discussion includes a presentation of diagnostic tools, including the Hare Psychology Checklist – Revised, which are examined in relationship to the importance of biological gender. While emphasizing the similarities as well as the differences between the sexes, we discuss the matters of prevalence, behavioral expressions, comorbidity, progression, and treatment of the disorder.Keywords: psychopathy, antisocial, dissocial, personality disorder, sex, women, review
Underwood, Marion K; Beron, Kurt J; Rosen, Lisa H
This investigation examined the relation between developmental trajectories jointly estimated for social and physical aggression and adjustment problems at age 14. Teachers provided ratings of children's social and physical aggression in Grades 3, 4, 5, 6, and 7 for a sample of 255 children (131 girls, 21% African American, 52% European American, 21% Mexican American). Participants, parents, and teachers completed measures of the adolescent's adjustment to assess internalizing symptoms, rule-breaking behaviors, and borderline and narcissistic personality features. Results showed that membership in a high and rising trajectory group predicted rule-breaking behaviors and borderline personality features. Membership in a high desister group predicted internalizing symptoms, rule-breaking behaviors, and borderline and narcissistic personality features. The findings suggest that although low levels of social and physical aggression may not bode poorly for adjustment, individuals engaging in high levels of social and physical aggression in middle childhood may be at greatest risk for adolescent psychopathology, whether they increase or desist in their aggression through early adolescence.
Kimberly Ann Jones RN, BScN, MN
Full Text Available Frequently stigmatized, misdiagnosed, improperly treated, and discounted is the suffering of the patient with Borderline Personality Disorder (BPD, and it can be a serious, agonizing, tenacious, and draining mental illness. Present-day research illustrates that patients with BPD are in fact the largest consumers of mental health services, utilizing every treatment genre more frequently and in greater quantities than any other mental health taxonomy. They experience more complex and destructive symptoms, more perpetual misery and encumbrance, an unpredictable usage of outpatient services, and extensive treatment modalities and psychiatric admissions. A review of current literature reveals this consistent notion: the attitudes of health care professionals toward patients diagnosed with this elaborate disorder tend to be disparaging. The aim of this article is to critically analyze the prospect that autoethnography (or narrative research is a strategic, useful tool for mental health professionals to improve empathy and identification with patients suffering with BPD. As a qualitative research method, autoethnography is advantageous for creating connections between care provider and patient. It can deepen their mutual and divergent experiences while generating empirical knowledge from the professional's narrative reflection and through the therapeutic use of self with the patient.
Anestis, Michael D; Gratz, Kim L; Bagge, Courtney L; Tull, Matthew T
The primary purpose of this study was to examine the interactive effect of borderline personality disorder (BPD) and distress tolerance (DT) on suicidal behavior across levels of intent to die (clear vs ambiguous) and medical severity. One hundred seventy-six adult patients in residential substance use disorder treatment were administered a series of structured interviews, behavioral assessments, and self-report questionnaires. A series of analyses of covariance and multiple regression analyses were conducted to test hypotheses using both categorical and dimensional measures of BPD and DT. Analyses supported hypotheses, indicating that patients with BPD who exhibit high DT are at the greatest risk for engaging in chronic and medically serious suicidal behavior. Although high DT is unlikely to be inherently problematic, results suggest that within the context of severe psychopathology (eg, co-occurring BPD-substance use disorder), the ability to withstand aversive internal states in pursuit of a goal (eg, one's own death) may enable individuals to persist in otherwise unsustainable behavior. In this sense, DT may function in a manner consistent with the acquired capability for suicide (a component of the interpersonal-psychological theory of suicidal behavior defined by a diminished fear of death and enhanced tolerance for pain that, in the presence of suicidal desire, enables individuals to enact lethal self-injury).
Vaillancourt, Tracy; Brittain, Heather L; McDougall, Patricia; Krygsman, Amanda; Boylan, Khrista; Duku, Eric; Hymel, Shelley
Developmental cascade models linking childhood physical and relational aggression with symptoms of depression and attention-deficit/hyperactivity disorder (ADHD; assessed at ages 10, 11, 12, 13, and 14) to borderline personality disorder (BPD) features (assessed at age 14) were examined in a community sample of 484 youth. Results indicated that, when controlling for within-time covariance and across-time stability in the examination of cross-lagged relations among study variables, BPD features at age 14 were predicted by childhood relational aggression and symptoms of depression for boys, and physical and relational aggression, symptoms of depression, and symptoms of ADHD for girls. Moreover, for boys BPD features were predicted from age 10 ADHD through age 12 depression, whereas for girls the pathway to elevated BPD features at age 14 was from depression at age 10 through physical aggression symptoms at age 12. Controlling for earlier associations among variables, we found that for girls the strongest predictor of BPD features at age 14 was physical aggression, whereas for boys all the risk indicators shared a similar predictive impact. This study adds to the growing literature showing that physical and relational aggression ought to be considered when examining early precursors of BPD features.
Beblo, Thomas; Pastuszak, Anna; Griepenstroh, Julia; Fernando, Silvia; Driessen, Martin; Schütz, Astrid; Rentzsch, Katrin; Schlosser, Nicole
Emotional dysfunction is a key feature of patients with borderline personality disorder (BPD) but emotional intelligence (EI) has rarely been investigated in this sample. This study aimed at an investigation of ability EI, general intelligence, and self-reported emotion regulation in BPD. We included 19 patients with BPD and 20 healthy control subjects in the study. EI was assessed by means of the Mayer-Salovey-Caruso emotional intelligence test and the test of emotional intelligence. For the assessment of general intelligence, we administered the multidimensional "Leistungsprüfsystem-Kurzversion." The emotion regulation questionnaire and the difficulties in Emotion Regulation Scale were used to assess emotion regulation. The patients with BPD did not exhibit impairments of ability EI and general intelligence but reported severe impairments in emotion regulation. Ability EI was related both to general intelligence (patients and controls) and to self-reported emotion regulation (patients). In conclusion, emotional dysfunction in BPD might primarily affect self-perceived behavior rather than abilities. Intense negative emotions in everyday life may trigger dysfunctional emotion regulation strategies in BPD although patients possess sufficient theoretical knowledge about optimal regulation strategies.
Minzenberg, Michael J; Poole, John H; Vinogradov, Sophia
Borderline personality disorder (BPD) is a paradigmatic disorder of adult attachment, with high rates of antecedent childhood maltreatment. The neurocognitive correlates of both attachment disturbance and maltreatment are both presently unknown in BPD. This study evaluated whether dimensional adult attachment disturbance in BPD is related to specific neurocognitive deficits, and whether childhood maltreatment is related to these dysfunctions. An outpatient BPD group (n=43) performed nearly 1 SD below a control group (n=26) on short-term recall, executive, and intelligence functions. These deficits were not affected by emotionally charged stimuli. In the BPD group, impaired recall was related to attachment-anxiety, whereas executive dysfunction was related to attachment-avoidance. Abuse history was correlated significantly with executive dysfunction and at a trend level with impaired recall. Neurocognitive deficits and abuse history exhibited both independent and interactive effects on adult attachment disturbance. These results suggest that (a) BPD patients' reactivity in attachment relationships is related to temporal-limbic dysfunction, irrespective of the emotional content of stimuli, (b) BPD patients' avoidance within attachment relationships may be a relational strategy to compensate for the emotional consequences of frontal-executive dysregulation, and (c) childhood abuse may contribute to these neurocognitive deficits but may also exert effects on adult attachment disturbance that is both independent and interacting with neurocognitive dysfunction.
Annemiek van Dijke
Full Text Available Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s (TPC and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD, somatoform disorder (SoD, both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-rating Inventory for Posttraumatic Stress Disorder (SRIP and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ranging from approximately 50% of patients with SoD or other psychiatric disorders to more than 75% of patients with comorbid BPD + SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch 0–6 years. Over-regulation of affect was associated with physical TPC. Childhood trauma by a primary caretaker is prevalent among psychiatric patients, particularly those with BPD, and differentially associated with underand over-regulation of affect depending on the type of traumatic exposure.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online
Buchheim, Anna; Erk, Susanne; George, Carol; Kächele, Horst; Martius, Philipp; Pokorny, Dan; Spitzer, Manfred; Walter, Henrik
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients' inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
Buchheim, Anna; Erk, Susanne; George, Carol; Kächele, Horst; Martius, Philipp; Pokorny, Dan; Spitzer, Manfred; Walter, Henrik
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear. PMID:27531977
Gratz, Kim L; Bardeen, Joseph R; Levy, Roy; Dixon-Gordon, Katherine L; Tull, Matthew T
Despite growing evidence for the efficacy of Gratz and colleagues' emotion regulation group therapy (ERGT) for deliberate self-harm (DSH) among women with borderline personality disorder (BPD), the proposed mechanism of change in this treatment (i.e., emotion regulation) remains largely unexamined. This study examined change in emotion dysregulation as a mediator of the effects of this ERGT on DSH and BPD symptoms, as well as the extent to which change in emotion dysregulation during treatment predicts further improvements in DSH during a 9-month follow-up. Participants included 61 female outpatients with BPD and recent DSH who were randomly assigned to receive this ERGT in addition to their ongoing outpatient therapy immediately (n = 31) or after 14 weeks (n = 30). Measures of emotion dysregulation, DSH, and BPD symptoms were administered pre- and post-treatment or -waitlist, and at 9-months post-treatment (for participants in both conditions who received ERGT). Results from a series of mediation analyses provide further support for emotion regulation as a mechanism of change in this treatment. Specifically, results revealed that improvements in emotion dysregulation over the course of treatment mediated the observed reductions in BPD cognitive and affective symptoms during treatment and predicted further improvements in DSH during follow-up.
Full Text Available Individuals with borderline personality disorder (BPD are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging. Eleven female patients with BPD without posttraumatic stress disorder and seventeen healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System, an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for two minutes. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex and the rostral cingulate zone. We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
Full Text Available The presence of non-suicidal self-injury acts in Borderline Personality Disorder (BPD is very prevalent. These behaviors are a public health concern and have become a poorly understood phenomenon in the community. It has been proposed that the commission of non-suicidal self-injury might be related to a failure in the brain network regulating executive functions. Previous studies have shown that BPD patients present an impairment in their capacity to monitor actions and conflicts associated with the performance of certain actions, which suppose an important aspect of cognitive control.We used Event Related Potentials to examine the behavioral and electrophysiological indexes associated with the error monitoring in two BPD outpatients groups (17 patients each differentiated according to the presence or absence of non-suicidal self-injury behaviors. We also examined 17 age- and intelligence- matched healthy control participants.The three groups did not show significant differences in event-related potentials associated with errors (Error-Related Negativity and Pe nor in theta power increase following errors.This is the first study investigating the behavioral and electrophysiological error monitoring indexes in BPD patients characterized by their history of non-suicidal self-injury behaviors. Our results show that error monitoring is preserved in BPD patients and suggest that non-suicidal self-injury acts are not related to a dysfunction in the cognitive control mechanisms.
Vega, Daniel; Vilà-Balló, Adrià; Soto, Àngel; Amengual, Julià; Ribas, Joan; Torrubia, Rafael; Rodríguez-Fornells, Antoni; Marco-Pallarés, Josep
Background The presence of non-suicidal self-injury acts in Borderline Personality Disorder (BPD) is very prevalent. These behaviors are a public health concern and have become a poorly understood phenomenon in the community. It has been proposed that the commission of non-suicidal self-injury might be related to a failure in the brain network regulating executive functions. Previous studies have shown that BPD patients present an impairment in their capacity to monitor actions and conflicts associated with the performance of certain actions, which suppose an important aspect of cognitive control. Method We used Event Related Potentials to examine the behavioral and electrophysiological indexes associated with the error monitoring in two BPD outpatients groups (17 patients each) differentiated according to the presence or absence of non-suicidal self-injury behaviors. We also examined 17 age- and intelligence- matched healthy control participants. Results The three groups did not show significant differences in event-related potentials associated with errors (Error-Related Negativity and Pe) nor in theta power increase following errors. Conclusions This is the first study investigating the behavioral and electrophysiological error monitoring indexes in BPD patients characterized by their history of non-suicidal self-injury behaviors. Our results show that error monitoring is preserved in BPD patients and suggest that non-suicidal self-injury acts are not related to a dysfunction in the cognitive control mechanisms. PMID:26636971
van Dijke, Annemiek; Ford, Julian D; van der Hart, Onno; Van Son, Maarten J M; Van der Heijden, Peter G M; Bühring, Martina
Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s) (TPC) and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD), somatoform disorder (SoD), both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-rating Inventory for Posttraumatic Stress Disorder (SRIP) and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ranging from approximately 50% of patients with SoD or other psychiatric disorders to more than 75% of patients with comorbid BPD+SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch 0-6 years. Over-regulation of affect was associated with physical TPC. Childhood trauma by a primary caretaker is prevalent among psychiatric patients, particularly those with BPD, and differentially associated with underand over-regulation of affect depending on the type of traumatic exposure.
Naoum, Janina; Reitz, Sarah; Krause-Utz, Annegret; Kleindienst, Nikolaus; Willis, Franziska; Kuniss, Sarah; Baumgärtner, Ulf; Mancke, Falk; Treede, Rolf-Detlef; Schmahl, Christian
Patients with Borderline Personality Disorder (BPD) often engage in non-suicidal self-injury (NSSI), to reduce arousal levels under stress. However, the importance of seeing blood for the effect of NSSI is yet unknown. The present pilot study examined 20 female BPD patients and 20 healthy controls (HC) to assess the role of seeing blood on arousal, pain, urge for NSSI (ratings) and heart rate (continuously measured). Participants completed two sessions consisting of stress induction (forced mental arithmetics with white noise), followed by a seven second non-invasive pain stimulus with a blade to the volar forearm. At one session, only the painful blade stimulus was applied, at the other, artificial blood was added. For arousal, a significantly stronger decrease was revealed in the BPD than in the HC group, however with no significant effects between blood and non-blood conditions. Concerning urge for NSSI, the BPD showed a significantly greater decrease in blood condition over time than the HC group. Interestingly, heart rate decreased stronger over time in the HC group during the blood condition than in BPD. For tension relief by non-damaging mechanical painful stimulus the addition of visible blood showed neither subjective (arousal, urge for NSSI), nor objective (heart rate) advantages.
Anthony Charles Ruocco
Full Text Available Self-harm is a potentially lethal symptom of borderline personality disorder (BPD that often improves with dialectical behavior therapy (DBT. While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.
Sadeh, Naomi; Londahl-Shaller, Esme A; Piatigorsky, Auran; Fordwood, Samantha; Stuart, Barbara K; McNiel, Dale E; Klonsky, E David; Ozer, Elizabeth M; Yaeger, Alison M
Rates of deliberate non-suicidal self-injury (NSSI) increase during adolescence and young adulthood, particularly in clinical samples, making these important developmental stages for understanding the functions of NSSI. Borderline Personality Disorder (BPD) symptoms also begin to emerge in adolescence, though little research has examined relationships between BPD symptoms and the functions of NSSI in youth, the primary goal of the present study. Adolescents and young adults recruited from an outpatient psychotherapy clinic (N=36) endorsed a range of NSSI functions on the Inventory of Statements about Self-Injury (Klonsky and Glenn, 2009). Participants engaged in NSSI to serve intrapersonal functions (e.g., regulate affect, punish oneself) more frequently than interpersonal functions (e.g., bond with peers, establish autonomy). As predicted, linear regression analyses indicated that BPD affective dysregulation symptoms were associated with the intrapersonal but not the interpersonal functions of NSSI. In contrast, BPD interpersonal dysfunction symptoms were differentially associated with the interpersonal rather than intrapersonal functions of NSSI. These preliminary data indicate that clusters of BPD symptoms show unique relationships with functions of NSSI in treatment-seeking adolescents and young adults, relationships that can be used to target specific functions of NSSI in treatment planning.
Turner, Brianna J; Dixon-Gordon, Katherine L; Austin, Sara B; Rodriguez, Marcus A; Zachary Rosenthal, M; Chapman, Alexander L
Although non-suicidal self-injury (NSSI) occurs in people with and without borderline personality disorder (BPD), few studies have compared the clinical characteristics of these two groups. The present study sampled adults with a history of NSSI and compared those with and without BPD on (a) NSSI features, (b) co-occurring psychiatric disorders, and (c) severity of depression, suicidal ideation and emotion dysregulation. Participants (NSSI+BPD, n=46; NSSI Only, n=54) completed semi-structured interviews and self-report measures. Whereas the groups did not differ in age of NSSI onset, the NSSI+BPD group engaged in more frequent, recent and severe NSSI, and reported higher rates of skin carving, head banging, self-punching and self-scratching than the NSSI Only group. Participants with BPD also showed greater diagnostic comorbidity, particularly for anxiety disorders, but did not differ from participants without BPD in rates of mood, substance or psychotic disorders. The NSSI+BPD group reported more severe depressive symptomatology, suicidal ideation and emotion dysregulation than the NSSI Only group. Supplementary analyses on the subset of participants with recent (past year) NSSI revealed similarly medium to large differences between those with and without BPD. Implications for assessment and treatment are discussed.
Scherpiet, Sigrid; Herwig, Uwe; Opialla, Sarah; Scheerer, Hanne; Habermeyer, Viola; Jäncke, Lutz; Brühl, Annette B
Borderline personality disorder (BPD) is associated with disturbed emotion regulation. Psychotherapeutic interventions using mindfulness elements have shown effectiveness in reducing clinical symptoms, yet little is known about their underlying neurobiology. In this functional magnetic resonance imaging (fMRI) study, 19 female BPD patients and 19 healthy controls were compared during mindful introspection, cognitive self-reflection and a neutral condition. The activation pattern in the right dorsomedial prefrontal cortex (DMPFC) in BPD patients was different from that in healthy subject when directing attention onto their emotions and bodily feelings in contrast to cognitively thinking about themselves. Mindful introspection compared with the neutral condition was associated with higher activations in bilateral motor/pre-motor regions, left inferior frontal gyrus (IFG), and left posterior cingulate cortex (PCC), while cognitive self-reflection activated the right motor and somatosensory cortex, extending into the right supramarginal gyrus (SMG) and superior temporal gyrus (STG) in BPD patients compared with the controls. Results indicate that self-referential cognitive and emotional processes are not clearly differentiated in BPD patients at the neurobiological level. In particular, altered neural mechanism underlying self-referential thinking may be related to some aspects of the typical emotion dysregulation in BPD. Current data support the finding that mindful self-focused attention is effective in regulating amygdala activity in BPD as well as in healthy subjects.
Gleason, Marci E J; Powers, Abigail D; Oltmanns, Thomas F
Both neuroticism and borderline personality disorder (BPD) are associated with increased frequency of stressful life events in young adults. It is not clear, however, whether this effect extends to later life because BPD is apparently diminished in frequency and severity when people reach middle adulthood. This issue was examined in a representative, community sample of men and women between the ages of 55 and 64 (N = 1,234). Ten DSM-IV PDs and neuroticism were assessed at baseline using a semistructured interview (SIDP-IV) and questionnaire (NEO-PI-R). Life events were measured 6 months later with a self-report questionnaire (LTE-Q) followed by a telephone interview. BPD features and neuroticism predicted increased frequency of life events, based on both self and interviewer-adjusted reports of negative life events. Avoidant and paranoid PD features predicted decreased frequency of negative life events. Approximately 42% of events reported on the LTE-Q were discounted following the telephone interview; higher scores on BPD symptoms were associated with more adjustments to self-report of threatening experiences. These findings indicate that symptoms of BPD and neuroticism continue to have a harmful impact on the lives of older adults.
Johnson, Benjamin N; Ashe, Melinda L; Wilson, Stephen J
Borderline personality disorder (BPD) and alcohol use disorder (AUD) share impulsivity as an etiological factor. However, impulsivity is ill-defined, often overlapping with self-control capacity. This study attempts to disentangle these constructs and their associations with alcohol use and BPD. Undergraduates (n = 192) completed the Five Factor Model Rating Form, which generated two-dimensional scales of BPD, the Self-Control Scale, the UPPS-P (self-reported impulsivity), and the stop-signal and delay discounting tasks (laboratory-measured impulsivity). Self-control appeared as a major predictor of BPD features and drinking, explaining as much or more variance in outcome than impulsivity. Co-occurrence of elevated BPD features and problem drinking was also best explained by self-control. Laboratory measures of impulsivity were not correlated with BPD scales or alcohol use. Self-regulatory capacity may be an important but overlooked factor in BPD and alcohol use and should be considered alongside impulsivity in future research.
Mentalization is a core concept in the modern treatment model for psychotherapy with personality disorders. The mentalization based treatment model presents a new view on how to understand the process of therapy, and has a view on how the therapist shall act and intervene in order to help...... of the concept of mentalization in music therapy treatment of people with diagnosed personality disorder. It will be based on integrating the theoretical perspective, on the process of therapy with focus on musical improvisation mostly. The clinical material will consist of exemplifying/illustrating vignettes....
Full Text Available Disorders such as borderline personality disorder (BPD or attention-deficit/hyperactivity disorder (ADHD are characterized by impulsive behaviors. Impulsivity as used in clinical terms is very broadly defined and entails different categories including personality traits as well as different cognitive functions such as emotion regulation or interference resolution and impulse control. Impulse control as an executive function, however, is neither cognitively nor neurobehaviorally a unitary function. Recent findings from behavioral and cognitive neuroscience studies suggest related but dissociable components of impulse control along functional domains like selective attention, response selection, motivational control and behavioral inhibition. In addition, behavioral and neural dissociations are seen for proactive versus reactive inhibitory motor control. The prefrontal cortex with its sub-regions is the central structure in executing these impulse control functions. Based on these concepts of impulse control, neurobehavioral findings of studies in BPD and ADHD were reviewed and systematically compared. Overall, BPD patients exhibited prefrontal dysfunctions across impulse control components rather in orbitofrontal, dorsomedial and dorsolateral prefrontal regions, whereas ADHD patients displayed disturbed activity mainly in ventrolateral and medial prefrontal regions. Prefrontal dysfunctions, however, varied depending on the impulse control component and from disorder to disorder. This suggests a dissociation of impulse control related frontal dysfunctions in BPD and ADHD, although only few studies are hitherto available to assess frontal dysfunctions along different impulse control components in direct comparison of these disorders. Yet, these findings might serve as a hypothesis for the future systematic assessment of impulse control components to understand differences and commonalities of prefrontal cortex dysfunction in impulsive disorders.
Snir, Avigal; Rafaeli, Eshkol; Gadassi, Reuma; Berenson, Kathy; Downey, Geraldine
Nonsuicidal self-injury (NSSI) is a perplexing phenomenon that may have differing motives. The present study used experience sampling methods (ESM) which inquired explicitly about the motives for NSSI, but also enabled a temporal examination of the antecedents/consequences of NSSI; these allow us to infer other motives which were not explicitly endorsed. Adults (n = 152, aged 18-65) with borderline personality disorder (BPD), avoidant personality disorder (APD), or no psychopathology participated in a 3-week computerized diary study. We examined 5 classes of explicit motives for engaging in NSSI, finding support primarily for internally directed rather than interpersonally directed ones. We then used multilevel regression to examine changes in affect, cognition, and behavior surrounding moments of NSSI acts/urges compared with control moments (i.e., without NSSI). We examined changes in 5 scales of inferred motives, designed to correspond to the 5 classes of explicit motives. The results highlight differing motives for NSSI among individuals with BPD and APD, with some similarities (mostly in the explicit motives) and some differences (mostly in the inferred motives) between the disorders. Despite their infrequent explicit endorsement, fluctuations in interpersonally oriented scales were found surrounding NSSI acts/urges. This highlights the need to continue attending to interpersonal aspects of NSSI in research and in clinical practice. Additionally, NSSI urges, like acts, were followed by decline in affective/interpersonal distress (although in a delayed manner). Thus, interventions that build distress tolerance and enhance awareness for affective changes, and for antecedent/consequence patterns in NSSI, could help individuals resist the urge to self-injure.
the patient enhance their capacity to mentalize. This improved ability to mentalize is at the core of the treatment model, and is considered to be essential to recovery. There are no prior writings about mentalization in a music therapeutical context. This chapter investigates and discusses the relevance...... of the concept of mentalization in music therapy treatment of people with diagnosed personality disorder. It will be based on integrating the theoretical perspective, on the process of therapy with focus on musical improvisation mostly. The clinical material will consist of exemplifying/illustrating vignettes.......Mentalization is a core concept in the modern treatment model for psychotherapy with personality disorders. The mentalization based treatment model presents a new view on how to understand the process of therapy, and has a view on how the therapist shall act and intervene in order to help...
van Asselt Thea; Spinhoven Philip; Eikelenboom Merijn; Giesen-Bloo Josephine; Smit Johannes H; Arntz Arnoud; Nadort Marjon; Wensing Michel; van Dyck Richard
Abstract Background Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the st...
Full Text Available Aim: This article addresses the problem of explaining emotional pathology (levels of personality organization using the concepts of theory of mind (ToM and mentalization. Although these terms are used interchangeably to describe the “ability to interpret the behavior of others in terms of mental states,” they do not have identical status in emotional disorders. ToM refers to a “cold” knowledge, whereas mentalization requires the activation of relational and emotional representations, as well as processing of emotional experience (whether reflection or defense. The aim of the study was to compare the cognitive (ToM and affective (mentalization aspects of “understanding the behavior of others in terms of mental states” in the clinical group – consisting of patients with borderline personality organization (N = 30; and the control group (N = 30. Method: The Borderline Personality Inventory was used as a diagnostic questionnaire for the organization of personality, the Strange Stories Test was employed to measure ToM, and the Mental States Task instrument measured mentalization. Results: With respect to mentalization, different patterns of results were obtained: the activation of overwhelming mental states and primitive defenses in the clinical group; as well as the inhibition of the recognition of mental content by defenses, such as denial and suppression of emotions, in the control group. No differences were observed in ToM between groups. Conclusions: In explaining the personality organization levels, only the affective, and not the cognitive, aspects of “understanding the behavior of others in terms of mental states” are significant. People with borderline personality organization, as well as healthy individuals, use “cold” knowledge about internal states. However, the activation of relational and emotional representations triggers different mental states in both groups.
Andrea L. Glenn
Full Text Available Several scholars have recognized the limitations of theories of moral reasoning in explaining moral behavior. They have argued that moral behavior may also be influenced by moral identity, or how central morality is to one's sense of self. This idea has been supported by findings that people who exemplify moral behavior tend to place more importance on moral traits when defining their self-concepts (Colby and Damon, 1995. This paper takes the next step of examining individual variation in a construct highly associated with IMMORAL behavior --- psychopathy. In Study 1, we test the hypothesis that individuals with a greater degree of psychopathic traits have a weaker moral identity. Within a large online sample, we found that individuals who scored higher on a measure of psychopathic traits were less likely to base their self-concepts on moral traits. In Study 2, we test whether this reduced sense of moral identity can be attributed to differences in moral judgment, which is another factor that could influence immoral behavior. Our results indicated that the reduced sense of moral identity among more psychopathic individuals was independent of variation in moral judgment. These results suggest that individuals with psychopathic traits may display immoral behavior partially because they do not construe their personal identities in moral terms.
West, M; Keller, A; Links, P; Patrick, J
In this paper, the authors investigate the theoretical and empirical association between dysfunctions of the attachment system and borderline personality disorder. Attachment theory focuses on the maintenance of a sense of safety and security through a close personal relationship with a particular person. Based on a biological behavioural system, functional attachment relationships in adulthood rely on experiences and expectations of security within the relationship. These issues are also important to the definition and dynamics of borderline personality disorder. The dimensions and patterns of reciprocal attachment were compared with other scales measuring components of psychopathology and interpersonal relationships. In a sample of 85 female outpatients, only four of the attachment scales--feared loss, secure base, compulsive care-seeking and angry withdrawal--identified patients with high scores on a measure of borderline disorder. Of these four scales, feared loss had the predominant effect. These empirical results support the hypothesized relationship between dysfunctions of the attachment system and borderline disorder.
EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER
Andreasson, Kate; Krogh, Jesper; Wenneberg, Christina
were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. RESULTS: At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14......BACKGROUND: Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. METHODS/DESIGN: The DiaS trial was designed...... behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes...
Full Text Available Background: A relationship between exposure to sexual violence and thyroid hormone alterations has been observed among women with posttraumatic stress disorder (PTSD. Women with borderline personality disorder (BPD report a high estimate of childhood trauma. Objective: The aim of the present study was to assess relationships between thyroid hormone measures and exposure to violence in childhood in women with BPD. Method: A total of 92 clinically euthyroid women with BPD (53% with comorbid PTSD diagnosis and at least two prior suicide attempts were assessed with the Karolinska Interpersonal Violence Scales (KIVS. The KIVS contains four subscales with concrete examples of exposure to violence and expressed violent behavior in childhood (aged 6–14 years and during adult life (15 years or older. Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3, thyroxine (FT4 and T4, and thyroid-stimulating hormone (TSH with immunoassays. The FT3/FT4 ratio was used to estimate peripheral deiodination. Plasma cortisol was also assessed. Results: Sixty-seven percent of patients reported medium high or high level of exposure to interpersonal violence as a child. The FT3/FT4 ratio showed a significant negative correlation with exposure to violence as a child. Patients with PTSD had significantly higher plasma cortisol levels. An ad hoc analysis revealed that the correlation between KIVS exposure to interpersonal violence as a child and FT3/FT4 ratio was significant only in patients with comorbid PTSD. Altered thyroid activity, especially FT3/FT4, levels was associated with exposure to violence in childhood in women with BPD. Conclusion: Severe childhood trauma-related stress may promote lasting altered thyroid levels and/or contribute to the development of psychopathology associated with BPD traits or PTSD.
Soloff, Paul H.; White, Richard; Omari, Amro; Ramaseshan, Karthik; Diwadka, Vaibhav A.
Emotion dysregulation in borderline personality disorder (BPD) is associated with loss of cognitive control in the face of intense negative emotion. Negative emotional context may interfere with cognitive processing through the dysmodulation of brain regions involved in regulation of emotion, impulse control, executive function and memory. Structural and metabolic brain abnormalities have been reported in these regions in BPD. Using novel fMRI protocols, we investigated the neural basis of negative affective interference with cognitive processing targeting these regions. Attention-driven Go No-Go and X-CPT (continuous performance test) protocols, using positive, negative and neutral Ekman faces, targeted the orbital frontal cortex (OFC) and the anterior cingulate cortex (ACC), respectively. A stimulus-driven Episodic Memory task, using images from the International Affective Pictures System, targeted the hippocampus (HIP). Participants comprised 23 women with BPD, who were compared with 15 healthy controls. When Negative>Positive faces were compared in the Go No-Go task, BPD subjects had hyper-activation relative to controls in areas reflecting task-relevant processing: the superior parietal/precuneus and thebasal ganglia. Decreased activation was also noted in the OFC, and increased activation in the amygdala (AMY). In the X-CPT, BPD subjects again showed hyper-activation in task-relevant areas: the superior parietal/precuneus and the ACC. In the stimulus-driven Episodic Memory task, BPD subjects had decreased activation relative to controls in the HIP, ACC, superior parietal/precuneus, and dorsal prefrontal cortex (dPFC) (for encoding), and the ACC, dPFC, and HIP for retrieval of Negative>Positive pictures, reflecting impairment of task-relevant functions. Negative affective interference with cognitive processing in BPD differs from that in healthy controls and is associated with functional abnormalities in brain networks reported to have structural or metabolic
Full Text Available Background: Patients with posttraumatic stress disorder (PTSD are prone to dissociation, which in theory should interfere with successful treatment. However, most empirical studies do not substantiate this assumption. Objective: The primary objective was to test whether state dissociation predicts the success of an adaptation of dialectical behavior therapy designed for the treatment of patients with PTSD after childhood sexual abuse (CSA (DBT-PTSD. We further explored whether the operationalization of dissociation as state versus trait dissociation made a difference with respect to prediction of improvement. Methods: We present a hypothesis-driven post hoc analysis of a randomized controlled trial on the efficacy in patients with PTSD after CSA. Regression analyses relating pre–post improvements in the Clinician-Administered PTSD Scale (CAPS and the Posttraumatic Diagnostic Scale (PDS to dissociation were applied to the women who participated in the active treatment arm (DBT-PTSD. Multivariate models accounting for major confounders were used to relate improvements in both the CAPS and the PDS to (1 state dissociation as assessed after each treatment session and (2 trait dissociation as assessed at baseline. Results: State dissociation during psychotherapy sessions predicted improvement after DBT-PTSD: patients with low state dissociation during treatment had a higher chance to show substantial improvement. This relation consistently emerged across subgroups of PTSD patients with and without borderline personality disorder. The operationalization of dissociation as state versus trait dissociation made a difference as improvement was not significantly predicted from trait dissociation. Conclusions: Dissociation during treatment sessions may reduce success with trauma-focused therapies such as DBT-PTSD. Accordingly, clinical studies aimed at improving ways to address dissociation are needed.
Full Text Available To determine pooled prevalence of clinically significant traits or features of Borderline Personality Disorder among college students, and explore the influence of methodological factors on reported prevalence figures, and temporal trends.Electronic databases (1994-2014: AMED; Biological Abstracts; Embase; MEDLINE; PsycARTICLES; CINAHL Plus; Current Contents Connect; EBM Reviews; Google Scholar; Ovid Medline; Proquest central; PsychINFO; PubMed; Scopus; Taylor & Francis; Web of Science (1998-2014, and hand searches.Forty-three college-based studies reporting estimates of clinically significant BPD symptoms were identified (5.7% of original search.One author (RM extracted clinically relevant BPD prevalence estimates, year of publication, demographic variables, and method from each publication or through correspondence with the authors.The prevalence of BPD in college samples ranged from 0.5% to 32.1%, with lifetime prevalence of 9.7% (95% CI, 7.7-12.0; p < .005. Methodological factors contributing considerable between-study heterogeneity in univariate meta-analyses were participant anonymity, incentive type, research focus and participant type. Study and sample characteristics related to between study heterogeneity were sample size, and self-identifying as Asian or "other" race. The prevalence of BPD varied over time: 7.8% (95% CI 4.2-13.9 between 1994 and 2000; 6.5% (95% CI 4.0-10.5 during 2001 to 2007; and 11.6% (95% CI 8.8-15.1 from 2008 to 2014, yet was not a source of heterogeneity (p = .09.BPD prevalence estimates are influenced by the methodological or study sample factors measured. There is a need for consistency in measurement across studies to increase reliability in establishing the scope and characteristics of those with BPD engaged in tertiary study.
Susan Brown; Francine Shapiro; 方莉
Individuals diagnosed with borderline personality disorder（BPD） usually experience significant impairment in their ability to function.Impulsivity,affect instability,interpersonal difficulties,and identity problems are hallmark features of this disorder,f%边缘型人格障碍（BPD）患者通常有显著的功能行使能力损害。其特征是冲动、情绪不稳、人际困难和身份认同问题,常常导致自杀行为和自杀姿态。虽然传统上认为BPD是一种慢性持久的障碍,但近期的研究却提示它可能会随着时间流逝而有所缓解,而且心理治疗可以促进缓解。BPD的病因与童年期虐待和不恰当的依恋关系有关。由于童年期虐待和创伤的重要意义,被公认有效的创伤治疗方法——眼动脱敏与再加工（EMDR）可能作为BPD的合理备选治疗方案之一。本文中的个案所获得的良好疗效阐明了EMDR在BPD治疗中的运用,提示有理由进行深入的
Meuldijk, Denise; McCarthy, Alexandra; Bourke, Marianne E.; Grenyer, Brin F. S.
Aim Borderline Personality Disorder (BPD) is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update. Methods Empirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $) using purchasing power parities. Results We identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50% of the quality criteria. The mean cost saving for treating BPD with evidence-based psychotherapy across studies was USD $2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range $83 - $29,392) was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found. Discussion Individuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread
Fossati, Andrea; Pincus, Aaron L; Borroni, Serena; Munteanu, Arina Ferrari; Maffei, Cesare
To understand the similarities and differences in personality traits and moral disengagement associated with pathological narcissism and psychopathy, 740 Italian active community members who voluntarily participated in the study were administered the Italian versions of the Pathological Narcissism Inventory, the Levenson Self-Report Psychopathy Scale, the HEXACO Personality Inventory, and the Moral Disengagement Scale. Hierarchical regression analyses showed that low Honesty-Humility and Antagonism (i.e., low Agreeableness) were personality traits common to both pathological narcissism and psychopathy, whereas low Conscientiousness was only related to psychopathy. Different associations with the HEXACO-PI scales and facets were observed for narcissistic grandiosity and narcissistic vulnerability, as well as for primary psychopathy and secondary psychopathy. Moral disengagement represented a common feature of pathological narcissism and psychopathy that was related to narcissistic vulnerability and to primary and secondary psychopathy, but not to narcissistic grandiosity.
Tárcia Rita Davoglio
Full Text Available Este artigo de revisão de literatura examinou o construto da psicopatia associado ao desenvolvimento da personalidade em crianças e adolescentes, privilegiando as questões diagnósticas incipientes. Observou-se que a busca de uma terminologia mais apropriada para descrever as manifestações desviantes precoces, a construção e utilização de instrumentos de avaliação dirigidos à psicopatia em jovens, bem como a estabilidade dos sintomas ao longo do desenvolvimento, têm sido preocupações recorrentes nas pesquisas atuais. Pode-se afirmar que a presença de traços de psicopatia na infância e adolescência ainda suscita questionamentos, demandando por estudos empíricos que explorem aspectos evolutivos e a etiologia multifatorial do construto, preferencialmente, dentro da concepção geral dos transtornos de personalidade.This literature review article examined the psychopathy construct associated to the development of personality in children and adolescents focusing on the incipient diagnostic issues. It was observed that the search for a more appropriate terminology for describing the early deviant manifestations, the building and using of instruments of evaluation directed to psychopathy in youngsters as well as the stability of the symptoms during growth have been recurrent issues in current researches. It can be affirmed that the presence of psychopathy traits in childhood and adolescence still raises doubts, requiring empirical studies which explore the evolutive aspects and the multifactorial etiology, preferentially within the general conception of personality disorders.
Blonigen, Daniel M.; Patrick, Christopher J.; Douglas, Kevin S.; Poythress, Norman G.; Skeem, Jennifer L.; Lilienfeld, Scott O.; Edens, John F.; Krueger, Robert F.
Research to date has revealed divergent relations across factors of psychopathy measures with criteria of "internalizing" (INT; anxiety, depression) and "externalizing" (EXT; antisocial behavior, substance use). However, failure to account for method variance and suppressor effects has obscured the consistency of these findings across distinct…
Blonigen, Daniel M.; Patrick, Christopher J.; Douglas, Kevin S.; Poythress, Norman G.; Skeem, Jennifer L.; Lilienfeld, Scott O.; Edens, John F.; Krueger, Robert F.
Research to date has revealed divergent relations across factors of psychopathy measures with criteria of "internalizing" (INT; anxiety, depression) and "externalizing" (EXT; antisocial behavior, substance use). However, failure to account for method variance and suppressor effects has obscured the consistency of these findings…
Wilberg, T; Urnes, O; Friis, S; Pedersen, G; Karterud, S
A self-report measure of the Five-Factor Model (FFM) of personality, NEO-PI-R, was administered to a sample of patients with borderline (BPD, N = 29) or avoidant PD (AVPD, N = 34), admitted to a day treatment program, to investigate the NEO-PI-R profiles of the disorders, and the ability of NEO-PI-R to discriminate between the two disorders. The diagnoses were assessed according to the LEAD standard. AVPD was associated with high levels of Neuroticism and Agreeableness, and low levels of Extraversion and Conscientiousness. BPD was associated with high levels of Neuroticism and low levels of Agreeableness, Extraversion, and Conscientiousness. Eighty-eight percent of the AVPD group had high scores on Neuroticism and low scores on Extraversion, whereas 65% of the BPD group were high on Neuroticism and low on Agreeableness. The Extraversion and Agreeableness scales of NEO-PI-R discriminated between patients with BPD and those with AVPD. Patients with BPD scored significantly higher on the Angry Hostility and Impulsiveness subscales of Neuroticism and significantly lower on three Extraversion subscales, three Agreeableness subscales, and one Conscientiousness subscale. At the DSM-IV criterion level, there were more significant relationships between the subscales of NEO-PI-R and the AVPD criteria than with the BPD criteria. The findings suggest that the FFM has good discriminating ability regarding BPD and AVPD. However, there may be a closer conceptual relationship between the FFM and AVPD than between the FFM and BPD.
Borderline personality disorder (BPD) is one of the most common personality disorder by now, and full of controversy. Nine diagnosis standards about BPD were established by DSM-Ⅳin 1994,and still in use today. As a lot of social problems are involved by this disease, such as child abuse, parenthood parentage anomaly, the nuclear family conflict, divorce, the change of the female characters and so on, more and more psychologists research this disease in order to better recognize the features of contemporary social psychological environment. And meanwhile, patient with BPD is often associated with severe mental problems such as anorexia, alcoholism, drug abuse, depression and suicide, etc. Although BPD is a common disease in foreign countries, it is still rarely known in China .This article discusses and investigates BPD emphatically from the diagnosis, clinical manifestations and therapy.%边缘型人格障碍是迄今为止最为普遍的一种人格障碍类型，同时也是争议不断的一种疾病。DSM-Ⅳ于1994年正式确立了边缘型人格障碍的九条诊断标准沿用至今。边缘型人格障碍患者常常伴有严重的精神问题（比如：厌食、酗酒、药物滥用、抑郁以及自杀等），通过各种治疗研究的深入发展，可以帮助患者改善边缘化症状。同时边缘型人格障碍涉及到很多关键性的社会问题（如：儿童虐待、亲子关系异常、核心家庭的冲突、离婚、女性角色的改变等）使越来越多的心理学家将研究视角投射到本疾病当中，以期从中更好的探讨当代社会的心理环境特征。虽然边缘型人格障碍在国外很常见，但该病在国内却依然鲜为人知，着重从边缘型人格障碍的诊断、临床表现及治疗入手，对边缘型人格障碍的研究进展进行综述。
Sheila E. Crowell
Full Text Available Borderline personality disorder (BPD is a complex psychiatric diagnosis characterized by dysregulated behaviors, emotions, cognitions, and interpersonal relationships. In recent years, developmental psychopathologists have sought to identify early origins of BPD, with the ultimate goal of developing and providing effective preventative interventions for those at highest risk. In addition to heritable biological sensitivities, many scholars assert that environmental and interpersonal risk factors contribute to the emergence and maintenance of key borderline traits. Nonetheless, many BPD researchers examine only affected individuals, neglecting the family, peer, couple, and other dynamic contextual forces that impinge upon individual-level behavior. In the past decade, however, theoretical and empirical research has increasingly explored the interpersonal causes, correlates, and consequences of BPD. Such work has resulted in novel research and clinical theories intended to better understand and improve interpersonal dynamics among those with borderline traits. A major objective for the field is to better characterize how interpersonal dynamics affect (and are affected by the behaviors, emotions, and thoughts of vulnerable individuals to either reduce or heighten risk for BPD.
Arola, Riikka; Antila, Henna; Riipinen, Pirkko; Hakko, Helinä; Riala, Kaisa; Kantojärvi, Liisa
Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals. The study sample consisted of 508 adolescents (age 13-17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare. A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24-29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38-13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61-38.76, pviolent criminality in males were conduct disorder (OR 4.05, CI 1.75-9.38, p=0.001), substance use disorder (OR 2.51, CI 1.22-5.17, p=0.012) and special services at school (OR 2.58, CI 1.16-5.76, p=0.021). Females with Borderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD.
Demakis, George; Rimland, Casey; Reeve, Charlie; Ward, Jonathan
This study examined the influence of psychopathy and intelligence on malingering in a simulated malingering design. We hypothesized that participants high in both traits would be more adept at evading detection on performance validity tests (PVTs). College students (N = 92) were first administered the Wechsler Test of Adult Reading, a reading measure that estimates intelligence, and the Psychopathic Personality Inventory-Short Form under standard conditions. They were then asked to imagine as if they had suffered a concussion a year ago and were instructed to fake or exaggerate symptoms in a believable fashion to improve their settlement as part of a lawsuit. Participants were subsequently administered a brief neuropsychological battery that included the Word Memory Test, Rey 15-Item Test with Recognition, Finger-Tapping Test, and Digit Span from the Wechsler Adult Intelligence Scale-Fourth Edition. Moderated multiple regressions with hierarchical entry were conducted. Intelligence, psychopathy, and the interaction of intelligence and psychopathy were not related to performance on any of the PVTs. In other words, participants who scored higher on intelligence and psychopathy did not perform differently on these measures compared with other participants. Though a null finding, implications of this study are discussed in terms of the broader research and clinical literature on malingering.
Full Text Available Dysfunctional interpersonal patterns are a defining feature of Borderline Personality Disorder (BPD. A number of studies have aimed to determine if there are specific patterns in the interpersonal functioning of patients with BPD. The vast majority of these studies have used a widely-used rating system called the Core Conflictual Relationship Theme method . To date, three main models of interpersonal functioning of patients with BPD have been developed using the CCRT [2, 3] including one model developed by ourteam . The aim of this study was to examine to what extent these three empirically-derived models of interpersonal functioning in patients with BPD overlap.
Walters, Glenn D
The concept of psychopathy, as defined by Robert Hare, is reviewed with respect to its status as a general theory of crime. A hybrid of the medical pathology model and personality trait approach, the psychopathy concept proposes that a significant portion of serious crime is committed by psychopathic individuals. Hare's version of psychopathy, besides demonstrating weak applicability and a propensity for tautology, is subject to labeling effects, oversimplicity, reductionism, the fundamental attributional error, inattention to context, and disregard for the dynamic nature of human behavior. It is concluded that the psychopathy concept is substantially limited with respect to its ability to describe and clarify general criminal behavior but that it may still have value as a partial explanation for certain types of non-criminal predatory behavior.
Christopher T. A. Gillen
Full Text Available The current study is the first to investigate whether individual differences in personality are related to improved first impression accuracy when appraising psychopathy in female offenders from thin-slices of information. The study also investigated the types of errors laypeople make when forming these judgments. Sixty-seven undergraduates assessed 22 offenders on their level of psychopathy, violence, likability, and attractiveness. Psychopathy rating accuracy improved as rater extroversion-sociability and agreeableness increased and when neuroticism and lifestyle and antisocial characteristics decreased. These results suggest that traits associated with nonverbal rating accuracy or social functioning may be important in threat detection. Raters also made errors consistent with error management theory, suggesting that laypeople overappraise danger when rating psychopathy.
Full Text Available ... and behaviors by teaching skills to: Control intense emotions Reduce self-destructive behaviors Improve relationships With DBT, ... concrete things they can do to manage their emotions when certain challenging situations arise and they are ...
... used to sustain the patient through periods of crisis and encourage small gains over time. This approach encourages the transformation from acting out to verbalizing psychological conflicts and developing adaptive outlets for emotions. X ...
... Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder Eating Disorders Among Adults - Bulimia Nervosa Eating Disorders ... Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder Eating Disorders Among Adults - Bulimia Nervosa Eating Disorders ...
Full Text Available ... identify and verbally express their emotions, describe their interactions with other people, and talk about themselves and ... stress (particularly the stress of rejection or disappointing interactions with other people). Supportive Psychotherapy A form of ...
Full Text Available ... Mentalization-Based Therapy (MBT) Mentalization refers to the ability to focus and reflect on beliefs, intentions, feelings, and thoughts in oneself and in others. This ability is thought to be compromised among people with ...
Full Text Available ... options exist. Transference-Focused Psychotherapy (TFP) Dialectical Behavior Therapy (DBT) Other forms of therapy for BPD include: ... than acting out these emotions impulsively. Schema-Focused Therapy (SFT) This type of therapy focuses on reframing “ ...
Full Text Available ... behaviors Improve relationships With DBT, people learn tools, exercises, and concrete things they can do to manage ... symptoms and problem BPD behaviors, relieve symptoms of depression, and improve quality of life. Dynamic Deconstructive Therapy ( ...
... many areas of your life. It can negatively affect intimate relationships, jobs, school, social activities and self-image, resulting ... harm yourself or attempted suicide? Do you use alcohol or recreational drugs ... your relationship with your parents or caregivers? Were you physically ...
... unsafe sex, substance abuse, reckless driving, and binge eating Recurring suicidal behaviors or threats or self-harming behavior, such as ... Research on BPD treatment is focused on the development and evaluation of psychotherapy and pharmacological interventions to ...
McGlashan, Thomas H.; Grilo, Carlos M.; Sanislow, Charles A.; Ralevski, Elizabeth; Morey, Leslie C.; Gunderson, John G.; Skodol, Andrew E.; Shea, M. Tracie; Zanarini, Mary C.; Bender, Donna; Stout, Robert L.; Yen, Shirley; Pagano, Maria
Objective This study tracked the individual criteria of four DSM-IV personality disorders—borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders—and how they change over 2 years. Method This clinical sample of patients with personality disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or obsessive-compulsive personality disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four personality disorders by their variation in prevalence and changeability (remission) over time. Results The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal personality disorder, affective instability and anger for borderline personality disorder, feeling inadequate and feeling socially inept for avoidant personality disorder, and rigidity and problems delegating for obsessive-compulsive personality disorder. The least prevalent and most changeable criteria were odd behavior and constricted affect for schizotypal personality disorder, self-injury and behaviors defending against abandonment for borderline personality disorder, avoiding jobs that are interpersonal and avoiding potentially embarrassing situations for avoidant personality disorder, and miserly behaviors and strict moral behaviors for obsessive-compulsive personality disorder. Conclusions These patterns highlight that within personality disorders the relatively fixed criteria are more trait-like and attitudinal, whereas the relatively intermittent criteria are more behavioral and reactive. These patterns suggest that personality disorders are hybrids of traits and symptomatic behaviors and that the interaction of these elements over time helps determine diagnostic stability. These patterns may also inform criterion selection for
Müller, Jürgen L; Schuierer, Gerhard; Marienhagen, Jörg; Putzhammer, Albert; Klein, Helmfried E
"Psychopathy" describes a type of personality disorder characterized by a dysregulation of emotion processing. Social behaviour, emotion regulation and competency are of particular relevance in forensic psychiatry. Structural-morphological and functional imaging studies prove that emotion regulation, aggressive-impulsive behaviour and learning from negative experiences are greatly influenced by frontal brain regions. These abilities are impaired in severe cases of dissocial personality disorders and in traumatic "pseudopsychopathy". We illustrate the importance functional neurobiological changes in patients personality disorders and "acquired psychopathy" by two case reports on patients who were admitted to a forensic-psychiatric facility for sexual crimes.
Omar, Hussein; Tejerina-Arreal, Maria; Crawford, Mike J
Current U.K. guidelines on the management of borderline personality disorder include specific recommendations about the duration of therapy and number of sessions per week that patients should be offered. However, very little research has been conducted to examine the impact of these aspects of treatment process on patient outcomes. We therefore undertook a systematic review to examine the impact of treatment duration, number of sessions per week and access group-based therapy on general mental health, depression, social functioning and deliberate self-harm. We identified 25 randomized trials for possible inclusion in the review. However, differences in outcome measures used meant that only 12 studies could be included in the analysis. Statistically significant reductions in self-harm and depression and improvement in social functioning were found for treatments that include more than one session per week and those that included group-based sessions but were not found for those that deliver in individual sessions or one or fewer sessions per week. Longer term outcomes of short-term interventions have not been examined. Further research is needed to examine the impact of shorter term interventions and to compare the effects of group-based versus individual therapies for people with borderline personality disorder.
Falkenbach, Diana; Poythress, Norman; Falki, Marielle; Manchak, Sarah
The present study assessed the psychometric properties and construct validity of two self-report measures of psychopathy in a male-college sample: the Levenson Psychopathy scales (LPS; Levenson, Kiehl, & Fitzpatrick, 1995) and the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996). Both the LPS and the PPI demonstrated good…
Murrie, Daniel C.; Marcus, David K.; Douglas, Kevin S.; Lee, Zina; Salekin, Randall T.; Vincent, Gina
Background: Recently, researchers have sought to measure psychopathy-like features among youth in hopes of identifying children who may be progressing toward a particularly destructive form of adult pathology. However, it remains unclear whether psychopathy-like personality features among youth are best conceptualized as dimensional (distributed…
Mathieu, Cynthia; Hare, Robert D.; Jones, Daniel N.; Babiak, Paul; Neumann, Craig S.
Psychopathy is a clinical construct defined by a cluster of personality traits and behaviors, including grandiosity, egocentricity, deceptiveness, shallow emotions, lack of empathy or remorse, irresponsibility, impulsivity, and a tendency to ignore or violate social norms. The majority of empirical research on psychopathy involves forensic…
Individual differences in components of impulsivity and effortful control moderate the relation between borderline personality disorder traits and emotion recognition in a sample of university students.
Preti, Emanuele; Richetin, Juliette; Suttora, Chiara; Pisani, Alberto
Dysfunctions in social cognition characterize personality disorders. However, mixed results emerged from literature on emotion processing. Borderline Personality Disorder (BPD) traits are either associated with enhanced emotion recognition, impairments, or equal functioning compared to controls. These apparent contradictions might result from the complexity of emotion recognition tasks used and from individual differences in impulsivity and effortful control. We conducted a study in a sample of undergraduate students (n=80), assessing BPD traits, using an emotion recognition task that requires the processing of only visual information or both visual and acoustic information. We also measured individual differences in impulsivity and effortful control. Results demonstrated the moderating role of some components of impulsivity and effortful control on the capability of BPD traits in predicting anger and happiness recognition. We organized the discussion around the interaction between different components of regulatory functioning and task complexity for a better understanding of emotion recognition in BPD samples.
Copestake, Sonja; Gray, Nicola S; Snowden, Robert J
A dysfunction in the processing of emotional material has been suggested to underpin the concept of psychopathy, hence we hypothesized that individuals high in psychopathic traits should have low scores on measure of emotional intelligence (EI). We measured EI by using both an ability-based measure (Mayer-Salovey-Caruso Emotional Intelligence Test) and a self-report measure (Trait Meta-Mood Scale) in a sample of offenders. Psychopathy was measured by using both a clinical checklist (Psychopathy Checklist-Revised) and a self-report scale (Psychopathy Personality Inventory-Revised). We also took a measure of intellectual ability (Wechsler Abbreviated Scale of Intelligence) to assess any unique contribution from EI over that of IQ. We found that the concepts of EI (both ability-based and self-report) were related to IQ. We also found that there was a negative relationship between self-report EI and ability EI. In relation to psychopathy, the results did not support the hypotheses of a general deficit in EI. While the results relating different facets of psychopathy to different aspects of EI were complex, there was some evidence that some aspects of psychopathy were positively related to the unique variance related to EI once IQ was partialled out. We suggest that there is not a general deficit in EI in psychopathy, and that future research needs carefully to carefully consider just what aspects of psychopathy and of EI are being measured, and the influence of intellectual ability, before drawing conclusions on this matter.
Kuo, Janice R; Khoury, Jennifer E; Metcalfe, Rebecca; Fitzpatrick, Skye; Goodwill, Alasdair
Childhood abuse has been consistently linked with borderline personality disorder (BPD) and recent studies suggest that some forms of childhood abuse might be uniquely related to both BPD and BPD features. In addition, difficulties with emotion regulation have been found to be associated with childhood abuse, BPD, as well as BPD features. The present study examined (1) whether frequency of childhood emotional abuse is uniquely associated with BPD feature severity when controlling for other forms of childhood abuse and (2) whether difficulties with emotion regulation accounts for the relationship between childhood emotional abuse and BPD feature severity. A sample of undergraduates (n=243) completed the Childhood Trauma Questionnaire - Short Form, Difficulties in Emotion Regulation Scale, and Borderline Symptom List-23. Multiple regression analyses and Structural Equation Modeling were conducted. Results indicated that frequency of childhood emotional abuse (and not sexual or physical abuse) was uniquely associated with BPD feature severity. In addition, while there was no direct path between childhood emotional abuse, childhood physical abuse, or childhood sexual abuse and BPD features, there was an indirect relationship between childhood emotional abuse and BPD features through difficulties with emotion regulation. These findings suggest that, of the different forms of childhood abuse, emotional abuse specifically, may have a developmental role in BPD pathology. Prevention and treatment of BPD pathology might benefit from the provision of emotion regulation strategies.
Benning, Stephen D.; Patrick, Christopher J.; Salekin, Randall T.; Leistico, Anne-Marie R.
Psychopathy has been conceptualized as a personality disorder with distinctive interpersonal-affective and behavioral deviance features. The authors examine correlates of the factors of the Psychopathic Personality Inventory (PPI), Self-Report Psychopathy-II (SRP-II) scale, and Antisocial Process Screening Device (APSD) to understand similarities…
Full Text Available Immune reconstitution inflammatory syndrome describes a collection of inflammatory disorders associated with paradoxical deterioration of various pre-existing processes following start of highly active antiretroviral therapy (HAART in human immunodeficiency virus (HIV-infected patients. Leprosy as an opportunistic infection in immune reconstitution syndrome has been rarely reported in literature. A case of a 30-year-old HIV positive man with extrapulmonary tuberculosis of left foot on HAART having developed borderline tuberculoid leprosy as opportunistic infection in immune reconstitution syndrome has been reported.
Johnson, Harriette C.
Reviews current research on treatment of borderline clients with medication, individual counseling, and family interventions. Notes that recent studies indicate that borderline personality is heterogeneous condition in which different underlying disorders (affective, schizotypal, and neurological) may be present. Reviews effectiveness of various…
Beck, Emma; Bo, Sune; Gondan, Matthias
in diagnosing adolescent BPD, there is a lack of cost-effective evidence-based treatment programs for adolescents. Mentalization-based treatment is an evidence-based program for BPD, originally developed for adults. Methods/Design Aims/hypotheses: We will investigate whether a specifically designed......Background Evidence-based outpatient psychotherapeutic programs are first-line treatment of borderline personality disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages...... mentalization-based treatment in groups is an efficacious treatment for adolescents with BPD or subthreshold BPD compared to treatment as usual. The trial is a four-center, two-armed, parallel-group, assessor-blinded randomized clinical superiority trial. One hundred twelve patients aged 14 to 17 referred...
Jeung, Haang; Schwieren, Christiane; Herpertz, Sabine C
Borderline Personality Disorder (BPD) is characterized by severe and persistent impairments in interpersonal functioning. Given the complexity of social interactions, studying the interactive behavior of BPD patients is challenging. One way to implement both tight experimental control and realistic, externally valid settings is to use game-theoretical experiments. This review discusses findings from economic exchange studies in BPD against the background of game-theoretical literature. BPD patients do not seem to derive utility from mutual cooperation with others and appear not to "forgive" a partner's unfairness. By pursuing a strategy of negative reciprocity, BPD patients seem to act mostly "rationally" and in their own self-interest. Their "grim trigger strategy" resembles the theoretical ideal of the rational and self-interested agent homo economicus. Finally, we summarize how research findings from economics and clinical psychiatry may be mutually enriching and propose new research ideas in this fascinating field.
张红; 缪绍疆; 童俊
@@ 边缘型人格障碍(borderline personality disorder,BPD)在精神疾病诊断中是一个新的疾病类型,这种障碍引起了人们越来越多的注意.它在发达国家的认识过程也是近一二十年的事情,在中国更是近几年的事情.BPD是一组严重、慢性、不稳定的精神疾病,最近有研究表明11%的精神科门诊病人和19%的精神科住院病人可以被诊断为边缘型人格障碍~().
Koenig, Julian; Rinnewitz, Lena; Parzer, Peter; Resch, Franz; Thayer, Julian F; Kaess, Michael
Vagally mediated heart rate variability (vmHRV) is reduced in borderline personality disorder (BPD). Non-suicidal self-injury (NSSI) is associated with comorbid psychopathology, in particular BPD. We aimed to examine differences in cardiac function (vmHRV and heart rate [HR]) comparing adolescents (12-17 years) engaging in NSSI (n=30) and healthy controls (n=30). Further, we aimed to determine clinical concomitants of cardiac function in patients with NSSI. Analyses showed no significant group differences on cardiac function. Controlling for a host of confounding variables resting state HR and vmHRV in adolescents with NSSI were significantly correlated with BPD symptoms and the current level of functioning.
Fassbinder, Eva; Hauer, Andrea; Schaich, Anja; Schweiger, Ulrich; Jacob, Gitta A; Arntz, Arnoud
Borderline personality disorder (BPD) is a severe, highly prevalent mental disorder. Effective psychological treatments for BPD are available. However, most patients do not receive evidence-based treatments partly because of high treatment delivery costs and lack of specialized therapists. By integrating specialized e-health tools into BPD-specific treatments, treatment intensity can be increased, frequency of face-to-face sessions and burden for psychotherapists can be reduced, and implementation of new skills and experiences in the everyday life of these patients can be promoted. This bears great potential to increase the availability of evidenced-based psychotherapy for BPD patients and close the gap between demand and supply. In this article we present such an innovative e-health tool, priovi, which has been developed for schema therapy. The concept and application of priovi are described and illustrated with a case example.
Unoka, Zsolt Szabolcs; Fogd, Dóra; Seres, Imola; Kéri, Szabolcs; Csukly, Gábor
Disturbed interpersonal relationships specific to borderline personality disorder (BPD) suggest biased processing of social information. The goal of this study was to examine alterations in mental state decoding (MSD) and their associations with early maladaptive schemas (EMS) that may lead to the misinterpretation of incoming information. In addition, the authors' aim was to evaluate the effects of a co-occurring current major depressive episode (MDE) on the MSD performance of BPD patients. Seventy-eight BPD patients (34 with MDE) and 76 matched healthy controls (HC) were assessed for Reading the Mind in the Eyes Test (RMET) and the level of EMS. The authors found that impairment in the total RMET performance, as well as specific impairment regarding the recognition of positive and neutral items, was associated with EMS, and enhanced vigilance to negative mental states was characteristic to BPD with MDE. Results suggest that MSD ability is altered in two independent ways in BPD.
Maria V Nararro-Haro
Full Text Available Borderline personality disorder (BPD is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT® is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resources. Most patients with BPD never receive DBT®. Incorporating computer technology into the DBT® could help increase dissemination. Immersive Virtual Reality technology (VR is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly floating down a 3D computer-generated river while listening to DBT® mindfulness training audios. Urges to suicide, self-harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session. VR mindfulness was well accepted/liked by the patient, and increased positive emotions. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT® skills treatment modules would reduce cost and increase dissemination.
Nararro-Haro, Maria V.; Hoffman, Hunter G.; Garcia-Palacios, Azucena; Sampaio, Mariana; Alhalabi, Wadee; Hall, Karyn; Linehan, Marsha
Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resources. Most patients with BPD never receive DBT®. Incorporating computer technology into the DBT® could help increase dissemination. Immersive Virtual Reality technology (VR) is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly “floating down” a 3D computer-generated river while listening to DBT® mindfulness training audios. Urges to commit suicide, urges to self harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session and VR mindfulness was well accepted/liked by the patient. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT® skills treatment modules would reduce cost and increase dissemination. PMID:27853437
Dean, Andy C; Altstein, Lily L; Berman, Mitchell E; Constans, Joseph I; Sugar, Catherine A; McCloskey, Michael S
Although risky decision-making has been posited to contribute to the maladaptive behavior of individuals with psychopathic tendencies, the performance of psychopathic groups on a common task of risky decision-making, the Iowa Gambling Task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994), has been equivocal. Different aspects of psychopathy (personality traits, antisocial deviance) and/or moderating variables may help to explain these inconsistent findings. In a sample of college students (N = 129, age 18 to 27), we examined the relationship between primary and secondary psychopathic features and IGT performance. A measure of impulsivity was included to investigate its potential as a moderator. In a joint model including main effects and interactions between primary psychopathy, secondary psychopathy and impulsivity, only secondary psychopathy was significantly related to risky IGT performance, and this effect was not moderated by the other variables. This finding supports the growing literature suggesting that secondary psychopathy is a better predictor of decision-making problems than the primary psychopathic personality traits of lack of empathy and remorselessness.
Relationship between emotion regulation and emotional intelligence in borderline personality disorder [Strategie regulacji emocji a inteligencja emocjonalna u pacjentów z zaburzeniem osobowości borderline
Full Text Available Aim. A typical trait of borderline personality disorder is emotional instability. The strategies that patients with BPD use to regulate their affects are not yet known. The purpose of presented research was an attempt to find the often used emotion regulation strategies, the eventual differences in value of emotional intelligence between BPD patients and healthy controls, and a relationship between emotion regulation and emotional intelligence in BPD. The work on FrAGe (an own self-descriptive tool which asks about different emotion regulation strategies, has also been included in this research. Methods. The investigation – which is a part of a wider project – was conducted in the Clinic of Psychiatry and Psychotherapy Bethel in Bielefeld, Germany. Subjects were 19 patients with diagnosis of BPD and 20 healthy people as a control group. Tools used in the diagnostic part of the research were: Mini – DIPS, SKID II. In order to verify the hypothesis were used: 1. to assess emotion regulation: FrAGe, ERQ, DERS, 2. to assess EI: MSCEIT, TEMINT; 3. for the assessment of general intelligence: LPS – K. Results. BPD patients reported severe impairments in emotion regulation – there are significant differences between groups in frequency of using the individual strategies of emotional regulation, negative and positive as well – but did not exhibit impairments of ability EI. The results do not prove the dependence between emotion regulation strategies and the global value of EI. Conclusions. Emotional dysfunction in BPD might affect a self perceived behaviour of the patients rather than their abilities: patients seems to possess a sufficient theoretical knowledge about functioning in the emotional context.
Full Text Available The present study is a replication of Falkenbach, Howe, and Falki (2013. Using self-esteem to disaggregate psychopathy, narcissism, and aggression. Personality and Individual Differences, 54(7, 815-820.
Elise M Cardinale
Full Text Available Psychopathy is a personality variable associated with persistent immoral behaviors. Despite this, attempts to link moral reasoning deficits to psychopathic traits have yielded mixed results with many findings supporting intact moral reasoning in individuals with psychopathic traits. Abundant evidence shows that psychopathy impairs responses to others' emotional distress. However, most studies of morality and psychopathy focus on judgments about causing others physical harm. Results of such studies may be inconsistent because physical harm is an imperfect proxy for emotional distress. No previous paradigm has explicitly separated judgments about physical harm and emotional distress and assessed how psychopathy affects each type of judgment. In three studies we found that psychopathy impairs judgments about causing others emotional distress (specifically fear but minimally affects judgments about causing physical harm and that judgments about causing fear predict instrumental aggression in psychopathy. These findings are consistent with reports linking psychopathy to insensitivity to others' fear, and suggest that sensitivity to others' fear may play a fundamental role in the types of moral decision-making impaired by psychopathy.
Simonsen, Erik; Andersen, Rune
Borderline personality disorder (BPD) is a severe psychiatric disorder characterised by instability of affect regulation, impulse control, interpersonal relationships, and self-image. The aim of this status article is to provide a brief overview of the neurobiological underpinnings of the core...
Andersen, Rune; Simonsen, Erik
Borderline personality disorder (BPD) is a severe psychiatric disorder characterised by instability of affect regulation, impulse control, interpersonal relationships, and self-image. The aim of this status article is to provide a brief overview of the neurobiological underpinnings of the core di...
Babiak, Paul; Neumann, Craig S; Hare, Robert D
There is a very large literature on the important role of psychopathy in the criminal justice system. We know much less about corporate psychopathy and its implications, in large part because of the difficulty in obtaining the active cooperation of business organizations. This has left us with only a few small-sample studies, anecdotes, and speculation. In this study, we had a unique opportunity to examine psychopathy and its correlates in a sample of 203 corporate professionals selected by their companies to participate in management development programs. The correlates included demographic and status variables, as well as in-house 360 degrees assessments and performance ratings. The prevalence of psychopathic traits-as measured by the Psychopathy Checklist-Revised (PCL-R) and a Psychopathy Checklist: Screening Version (PCL: SV) "equivalent"-was higher than that found in community samples. The results of confirmatory factor analysis (CFA) and structural equation modeling (SEM) indicated that the underlying latent structure of psychopathy in our corporate sample was consistent with that model found in community and offender studies. Psychopathy was positively associated with in-house ratings of charisma/presentation style (creativity, good strategic thinking and communication skills) but negatively associated with ratings of responsibility/performance (being a team player, management skills, and overall accomplishments).
Seibert, L Alana; Miller, Joshua D; Few, Lauren R; Zeichner, Amos; Lynam, Donald R
Self-report assessment of psychopathy is plagued by inconsistencies among the relations of the various psychopathy factors. We examined the factor structure of 3 prominent self-report measures of psychopathy-the Self-Report Psychopathy Scale-III (SRP-III; Williams, Paulhus, & Hare, 2007), the Levenson Self-Report Psychopathy Scale (LSRP; Levenson, Kiehl, & Fitzpatrick, 1995), and the Psychopathic Personality Inventory-R (PPI-R; Lilienfeld & Widows, 2005). A coherent 4-factor structure resulted from conducting an exploratory factor analysis (EFA) of the psychopathy subscales along with the domains from the five-factor model. Two of these factors were consistent with traditional conceptualizations of a 2-factor structure of psychopathy (i.e., Factor 1, which loaded negatively with Agreeableness; Factor 2, which loaded negatively with Conscientiousness), while 2 additional factors emerged, 1 of which emphasized low Neuroticism and 1 of which emphasized traits related to novelty/reward-seeking and dominance-related personality traits (high Extraversion). We also investigated the relations of these factors with a variety of externalizing behaviors (EB). The psychopathy scales indicative of interpersonal antagonism (i.e., Factor 1) were most consistently and strongly related to EB. Our findings are discussed in terms of the importance of a trait-based perspective in the assessment of psychopathy.
Meffert, Harma; Gazzola, Valeria; den Boer, Johan A.; Bartels, Arnold A. J.; Keysers, Christian
Psychopathy is a personality disorder associated with a profound lack of empathy. Neuroscientists have associated empathy and its interindividual variation with how strongly participants activate brain regions involved in their own actions, emotions and sensations while viewing those of others. Here
Penney, Stephanie R.; Moretti, Marlene M.; Da Silva, Kimberley S.
This study investigated the psychometric properties and predictive validity of three self-report scales (the Psychopathy Content Scale, the Psychopathy-16 scale, and the Egotistic scale) derived from the Millon Adolescent Clinical Inventory (MACI) to screen for the presence of psychopathic and narcissistic personality characteristics. Exploratory…
Vitacco, Michael J.; Neumann, Craig S.; Jackson, Rebecca L.
Although a 2-factor model has advanced research on the psychopathy construct, a 3-factor model was recently developed that emphasized pathological personality and eliminated antisocial behavior. However, dropping antisocial behavior from the psychopathy construct may not be advantageous. Using a large sample of psychiatric patients from the…
Bowles, David P; Armitage, Chris J; Drabble, Jennifer; Meyer, Björn
An experimental study investigated self-esteem and other-esteem responses to either fully supportive or less supportive interpersonal feedback in college students with avoidant and borderline personality disorder features (APD and BPD respectively). Disturbances in self-esteem and in evaluations of others are central to definitions of both APD and BPD, but the extent to which such interpersonal appraisals are responsive to contextual features, such as evaluative feedback from others, is not yet clear. In theory, we would expect that individuals with pronounced PD features would show more inflexible and more negative self-evaluations and others- evaluations than those without PD features. In this study with 169 undergraduates, APD but not BPD features were associated with other-contingent state self-esteem and other-esteem. A significant interaction indicated that highly avoidant respondents felt particularly negatively about themselves and their close others in situations that conveyed subtle criticism but not in situations signalling unequivocal support. This suggests that their self-esteem and other-esteem, rather than being rigidly negative, are instead highly contingent upon interpersonal feedback. Such context contingency has implications for the trait-like description of diagnostic characteristics within current taxonomies and is in line with contemporary dynamic models of personality structure and process.
Full Text Available Ales Grambal,1 Jan Prasko,1 Dana Kamaradova,1 Klara Latalova,1 Michaela Holubova,1,2 Marketa Marackova,1 Marie Ociskova,1 Milos Slepecky3 1Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Faculty of Social Science and Health Care, Department of Psychology Sciences, Constantine the Philosopher University, Nitra, Slovak Republic Introduction: Self-stigma arises from one’s acceptance of societal prejudices and is common in psychiatric patients. This investigation compares the self-stigma of a sample of patients with borderline personality disorder (BPD, schizophrenia spectrum disorder (SCH, major depressive disorder (MDD, bipolar affective disorder (BAD, and anxiety disorders (AD and explores of the self-stigma with the subjective and objective measures of the severity of the disorder and demographic factors. Methods: The total of 184 inpatients admitted to the psychotherapeutic department diagnosed with BPD, SCH, MDD, BAP, and AD were compared on the internalized stigma of mental illness (ISMI scale. The ISMI-total score was correlated with the subjective and objective evaluation of the disorder severity (clinical global impression, and clinical and demographic factors. Results: The self-stigma levels were statistically significantly different among the diagnostic groups (BPD 71.15±14.74; SCH 63.2±13.27; MDD 64.09±12.2; BAD 62.0±14.21; AD 57.62±15.85; one-way analysis of variance: F=8.698, df=183; P<0.005. However after applying the Bonferroni’s multiple comparison test, the only significant difference was between the BPD patients and the patients with AD (P<0.001. Stepwise regression analysis showed that the strongest factors connected with the higher level of self-stigma were being without partner, the number of hospitalization, and the severity of the disorder. Conclusion: The BPD patients
Kawamura S, Maesawa C, Nakamura K, Nakayama K, Morita M, Hiruma Y, Yoshida T, Sakai A, Masuda T
Full Text Available Satoshi Kawamura1, Chihaya Maesawa2, Koji Nakamura1, Kazuhiko Nakayama1, Michiaki Morita1, Yohei Hiruma1, Tomoyuki Yoshida3, Akio Sakai3, Tomoyuki Masuda41Department of Psychiatry, Tokyo Jikei University school of Medicine, Tokyo, Japan; 2Department of Tumor Biology, Division of Bioscience, center for Advanced Medical science, Iwate Medical University school of Medicine, Morioka, Japan; 3Department of Neuropsychiatry, Iwate Medical University school of Medicine, Morioka, Japan; 4Department of Pathology, Iwate Medical University school of Medicine, Morioka, JapanAbstract: Polycystic ovary syndrome (PCOS is a common lifestyle-related endocrinopathy in women of reproductive age and is associated with several mental health problems. We examined the genotypic distributions of IRS-1 Gly972Arg and CYP11B2 -344T/C, which were previously described as influencing PCOS, and assayed the serum levels of interleukin-6 (IL-6 and tumor necrosis factor-alpha (TNF-α, in a set of female patients with borderline personality disorder (BPD with comorbid major depressive disorder (MDD (n = 50 and age-matched control subjects (n = 100, to investigate the predisposition for BPD with MDD. The results showed that the patients were more frequently IRS-1 972Arg variant allele carriers (P = 0.013; OR 6.68; 95% CI = 1.30-34.43 and homozygous for the CYP11B2 -344C variant allele (P = 0.022; OR = 3.32; 95% CI = 1.18-9.35 than the control subjects. The IL-6 level was significantly higher in the patients than in the controls (P < 0.0001. There was no significant difference in the serum TNF-α level between patients with BPD with MDD and the healthy comparison group (P = 0.5273. In conclusion, the predisposition for BPD with MDD is associated with that for PCOS, in the female Japanese population. An elevated serum IL-6 level is considered to be a possible biomarker of BPD with MDD.Keywords: borderline personality disorder, depression, polycystic ovary syndrome, genetic